helen weld public health

2011-12-23T15:18:00.000-08:00

Trails of tears. . .

“There is a sacredness in tears. They are not marks of weakness, but of power. They speak more eloquently than ten thousand tongues. They are the messengers of overwhelming grief…and unspeakable love.” Washington Irving

It’s been two weeks since I have been home, but the images of being in Rwanda remain fresh and the friends/colleagues left behind are close to my heart.

The last weekend I was in Rwanda Alli and I went to Nyamata about 35 km. from Kigali where there is a Catholic church that is now a genocide memorial. This was intended to be a refuge for 5,000 Tutsis and “moderate” Hutus, but instead all but five were slaughtered on April 10, 1994. This is not a museum by any means, the “displays” are just there, almost as though the event happened in the recent past (although 18 years ago still seems too recent).

At the back of the modest brick church racks of stacked skulls, scapulae and femurs are housed. Bloodied garments are heaped in piles on either side of the concrete pews. Machetes and crude clubs riddled with nails are in piles near the altar. Remnants of people’s belongings are in a heap…shoes, a plastic yellow Gerry can for water, an identity card, a Bic pen and notebook. In the Sunday school area there is a brick wall that has been discoloured by the blood of hundreds of smashed infants’ skulls. Sorry to be so graphic, but this is a historic event that many people just choose to remain oblivious to or ignore. Those spaces felt as though there were thick veils of pain and suffering suspended in the air.

The reality of the genocide is closer as we now have friends who were directly affected. Both of us sat holding each other in the meditation garden at the memorial and wept which was therapeutic, but after spending the time there, we were both limp and drained. Haggling with the moto driver for the price of the return trip to Kigali seemed pointless, in fact after that morning every aspect of my “every day life” seems inconsequential.

When I am surrounded by the serene and bucolic beauty here, it’s harder to reflect on the challenges in Rwanda. I also find it disturbing that I am able to switch into the track of my “other” life almost too easily. I have been staying close to home enjoying the company of family and friends and taking long daily swims. Two minutes of the pre-Christmas mall scene for a very quick errand in Cairns was totally odious.

I just wish that I could converse easily and in depth in Kinyarwanda. At this point in my life, it just feels impossible that I could ever master this language enough to have real conversations and help people with their individual life journeys. Rwandan English speakers who have shared their stories with me, continually impress me with their ongoing sensitivity, wisdom and gratitude for life.

Leaving the extraordinary Gardens for Health community was an absolute heart wrench for me. I was deeply touched by everyone’s expressions of love and gratitude. I hope what I have tried to give and teach these resilient individuals will at least be equal to what I have received and learned from them. Perhaps I will be fortunate enough to return in 2012.

May we always remember to count our blessings. Here’s to a healthy and peaceful 2012 for all.

"Ambulance" in Kinyarwanda... a linguistic challenge for an aging brain

Helen's last Gikomero mama support group

Marie Therese, an extraordinary women with courage, resilience and compassion

A fun and special Sunday outing with some of my favourite women friends

'Heren' is touched by sweet love

Helen's airport sendoff

Counting daily blessings in Lake Eacham

2011-11-27T18:46:00.000-08:00

Family Without Borders. . .

Much of the past week focused on GHI's presentation at the Second Annual Nutrition Summit in Rwanda which included participants from Rwanda, Burundi, Zambia, Nigeria and Malawi at the Serena Hotel, Kigali's finest and fanciest.

The invitation for GHI to do this presentation was issued at the last minute which put us into high gear. For a variety of reasons it was decided Solange, our Rwandan colleague, would be the best person to represent GHI behind the podium. We worked together fine tuning the PowerPoint and then coached Solange for her first big public speaking debut. Kinyarwanda is her mother tongue, but the language choices were only French or English...she chose English. Practicing with her was a treat as it was obvious that she has many natural public speaking abilities, some of which were generated from her time doing radio.

Wednesday AM we had a final rehearsal at home and knew she was ready despite her butterflies. When she left her seat to go to the podium, I gave her hand a last squeeze. As her coaches and friends, we all felt like nervous but proud parents, sitting on the edge of our seats. From the beginning, she was utterly composed and progressed steadily through the slides with remarkable aplomb and a professional demeanor. We all felt like cheering upon her wrap up, as she had done an absolutely superb job.

Afterwards she had many "big wigs" from UNICEF, World Food Programme and FAO (the UN's Food and Agriculture Organization) come and give her their cards with great interest and support for GHI which was exciting and gratifying. It was an interesting opportunity to see where GHI needs to focus, but also wonderful to realise that the hard work and vision of GHI is on the right track. Throughout the two days of talks, it was apparent that GHI's integration of psychosocial/mental health support is unique and something which needs expansion.

There was also much focus this week on Thanksgiving and explaining the holiday to our Rwandan friends....an epilogue to our community celebration on 11/11/11. Images of turkeys and times with family were swirling in our heads. A group of us gathered Thursday night around a bountiful meal which was lovely and full of gratitude...as Brad aptly stated it was a "family without borders" celebration.

Helen

Solange arriving to the conference

Solange at the podium

GHI Thanksgiving table

2011-11-18T01:55:00.000-08:00

24 Hours In The DRC. . .

Climbing Nyiragongo, an active volcano in the Congo, was something that came up on my radar screen a few weeks ago, after hearing about it from a few friends here in Rwanda. The timing to slip away from GHI after the gigantic Thanksgiving event for a couple of days seemed good and the logistics fell into place, acquiring a visa and finding a reliable tour company. Despite some trepidation and much discussion about the implications of the upcoming elections in the Congo and the recent activity of another volcano, Mount Nyamulagira, three of us Metta, Johan and myself, decided to venture forth.

Camping on the shores of Lake Kivu at Gisenyi was a wonderful start to the adventure. A lovely dawn chorus and swim in the lake was a real treat. Watching the local fisherman paddle to shore in their threesome canoes after their night of work was a delightful image. Listening to their lilting sing-songy chanting/singing wafting through the sultry air, combined with a nearby church full of robust vocalists provided a great audio sensation too.

We were picked up promptly at 0730 by a man named Innocent, who assisted with the visa process on the Rwandan side (Gisenyi is right on the border). He then dropped us at the border where we were met by Roger, who assisted on the Congo side. It felt a bit like being part of the Underground Railroad with the handoffs from person to person.

The stark contrast between countries was immediately apparent and alarming. Gisenyi appears like the land of milk and honey with manicured parks and gardens vs. Goma’s depressed and battered streets, full of barbed wire and UN trucks and soldiers. Our route to the volcano climb took us through parts of Goma which had been swept away in the 2002 eruption of Nyiragongo. Tiny wooden clapboard houses on volcanic debris lined the roadways on both sides. Political posters, flags and banners were ubiquitous. There are 5 parliament positions open for Goma and 285 candidates for the November 28th election, 500 positions with 20,000 candidates for the entire country!

After about 30 minutes of car time we were dropped off at the park entrance. The bullet riddled sign is surely a photo op for many climbers (us included). After a briefing we set off with two armed guard/guides (one in the front, one in the rear), as well as a porter which I hired. I figured with my aging body and my decreased lung capacity that it was money well spent.

The entire climb took about 5 hours, including rests…The guide kept getting radio requests for updates from the base wondering about the “mama’s” status. They were obviously concerned about my abilities. His consistent replies, “she is strong”, were reassuring. We walked steadily through forest which opened up into lava fields (tricky footing) and then towards the summit of 3,400 meters (a gain of 1,400 meters). Part of the time it bucketed rain with nearby thunder which was a bit nerve wracking. Soaked to the skin, I required a change into dry gear at the last stop before reaching the top which was a STEEP climb.

Arriving at the rim was tantalizing as the crater and its lava were shrouded in mist, but the sounds were enormous; similar to gigantic Oahu breakers coming into shore and Yosemite scale waterfalls. When the skies cleared to reveal the lava it was utterly mind boggling. The lava is about 400 meters below, in a crater with a diameter of 3km. The deep orange of the lava was a colour I had never really seen. The rivers of lava looked like the patterns of the reticulations on a giraffe on one side and the other side like crashing waves of molten lava interspersed with mini eruptions throughout the whole field. It was totally mesmerizing to watch the lava for the few hours we were there.

Remembering to turn once in a while to see the other views of the Rwandan mountains, Lake Kivu, as well as the other volcano, Mount Nyamulagira, erupting smoke in the distance, helped keep the blood circulating...it was cold. The warmth from the lava wasn’t enough! Snuggling into the warm sleeping bag was a treat, though it took awhile to warm up… I especially missed Robert knowing how much he would have relished seeing the lava as well as for the warmth factor! I could see the orange glow and the waning moon as I drifted off to sleep.

We were up at 0500 for another session of lava viewing and then the 3 hour descent. Arriving back in Gisenyi and taking a moto to the bus for the trip back to Kigali makes one realise that the more “usual” risks in life are a reality too. Climbing Nyiragongo was a calculated risk/decision I will never regret…a life “bucket list” item.
Helen

Boats returning from a night of fishing

Mwende, the guide/guard

Helen with bullet riddled sign

Looking back towards Lake Kivu

Cabins on the crater rim

Helen overlooking the crater

View into the crater

Cauldron of lava

Helen on the rim

Dawn descent

Johan Helen Metta coming down
from Nyiragongo Volcano DRC

Smoke clouds from Nyamulagira volcano

Staples a la Goma

2011-11-13T13:46:00.000-08:00

11/11/11. . .

Despite formidable weather predictions and the previous days heavy downpours, the Second Annual GHI Thanksgiving celebration was blessed with sunshine throughout the whole day, with nary a spit of rain. After the grey days, colors seemed especially vibrant; large white cumulous clouds, cobalt blue skies, verdant fields and gardens, vermillion and orange flowers, local women wearing their finest gitenge fabrics and the GHI women (moi aussi) resembling Statue of Liberties (without the torch and crown) wearing brilliant green umushananas. The complete rainbow which came out Thursday afternoon was apparently good luck and helped make the event wonderful for the throngs.

The whole week had been a build up to Friday’s event, but the energy really began to focus on Thursday. The GHI staff gathered and tackled a variety of tasks; washing and peeling 200 kg of potatoes; washing, peeling and slicing 100kg of sweet potatoes for fries; husking 800 ears of corn; slaughtering five large goats (after we all gathered and gave thanks); making pennants and erecting a covering over the cooking area. We all (about 20 of us) spent the night on mattresses in the office and took short shifts of sleep. Throughout the night there were intermittent bouts of dancing keeping everyone refreshed. Good humour and a festive spirit abounded.

Dawn broke to clear skies on Friday…still many things on the list to check off…salad prep, and the beginning of serious cooking of beans, rice, corn, potatoes, goat, turkey, dodo (all done over open fires) by an incredible crew of strong and hard working women (Clair, Naomi and Anunciata) as well as volunteer women from the community. 4 large turkeys to kill and prepare, tents to erect, chairs to set up, speeches and skits to rehearse, plus a myriad of behind-the-scenes tasks.

People began to arrive by noon. Many had walked far distances for this event and carried offerings of their own garden harvests on their heads in agseke (lovely traditional baskets). One man brought sweet potatoes in a battered brief case. Sunday and Solange were a terrific duo as emcees, keeping the pre-meal schedule of events rolling in a timely manner. One community health worker/mama, Marceline, brought her six sets of twins (she also has two singles!) to do a song and dance performance. Two men wrote a song about GHI’s vision and service to the community weaving public health messages into the lyrics. Community women gave testimonials and performed traditional dances. Julie gave a speech in Kinyarwanda before we broke to serve the food.

We really had no exact count of the numbers of expected guests which made quantities of food a bit of a worry. There was never a final tally of an exact number of attendees, but judging the amount of chairs and plates used, we estimate between 800-900 people….maybe closer to 1,000 if you count babies on backs. There was a steady and serene queue receiving food for almost two hours. The circular flow began with a hand-washing station and continued around the ‘bingalow’. Each dish was served by one person (I was on beans). Brad ended the line distributing de-worming tablets and condoms. GHI friends came and helped too (dish washers galore) which was a fantastic bonus and added great fun to the festivities. The quantities were perfect and some even had seconds.

Before people headed home there were more skits conveying public health messages done by community members and the GHI mamas who were terrific and humorous. Per the Rwandan tradition of an elder closing off the day, I was asked to do a reading (Advice from a Tree by Ilan Shamir) and say a few words.

Clean up continued into the night under the full moon. Exhaustion set in by 9:30 and we piled onto the mattresses again. Just as we had put heads down, Rasta, GHI’s extraordinary carpenter/fixit man, who had worked so hard all night and day, came in to ask for help. His wife was in non-progressing labor at the local hospital and needing transfer to the district hospital. Brad and Julie went with a Rwandan friend to help. Brad ended up finishing the day delivering a healthy baby boy, Joshua, around 11:11 pm on 11/11/11. The full moon was in action!

I woke early to take a walk and survey the area where everyone had gathered before continuing with the cleaning up process. Flocks of lovely red finches flew by in a flock as the dawn broke. The airs still held the festive air of love and laughter of this amazing community of people. 11/11/11 was a day never to be forgotten.

Helen

Julie Thursday AM

Potato crew Thursday AM

Potato peeling 150kg to go

Full rainbow over GHI

Josean

Shucking corn

Drying dishes from pre-wash

Goat prepping

Metta & Johan

Pre-dawn sweet potato crew

Rasta minding the fire

One turkey down

Blood splattered Helen with next turkey

Venerend cooking up a storm

Alli and Helen as 'Statues of Liberty'

Brad, Julie & Solange

The crowds gather

Welcoming committee

Helen with Rubungo mamas

Marcelina and her twins, minus one

Anunciata & Naomi doing dishes

Lists checked off!

Julie finally sleeps. . .

2011-11-10T00:33:00.002-08:00

Preparations For GHI’s
Rwandan Thanksgiving. . .

A few of us went to Akagera National Park near the Tanzanian border on Sunday for a fabulous and full day of exploring. We saw water buffalo, wart hogs, baboons, gazelle, zebra, giraffes and so many amazing birds. It was lovely and refreshing to be out in the vast expanses of wild country. Small world again… we stopped by park headquarters before heading off , to see Sarah Hall (she and her husband are park administrators). Sarah’s father, Jeff, is a friend from Yungaburra in Queensland.

It’s been a bit of a swirl around here this week getting set for the huge feast on Friday (we are anticipating about 750 for lunch and festivities!) The regular routine of meetings, trainings, garden/farm work and CSA deliveries continues.

Torrential rain and difficult travel, no electricity or running water at our residence, the office printer going on the fritz, and all errands taking at least three times longer than expected, are giving everyone opportunities to practice infinite patience. Despite all these challenges, positive energy, enthusiasm and high spirits abound at GHI. It’s definitely a “hope for the best, prepare for the worst” sort of situation.

The “to do” lists are posted on the wall and the turkeys have arrived. The goats will be coming soon. We’ll be working with the local health centers to distribute condoms and worming medicine on Friday too, as well as making public health notices about hand washing.

We anticipate spending the night here tonight, hence the need for mattresses on today’s list! Let’s hope the sun decides to shine. Even if it doesn’t, everyone’s hearts will be brimming with love.

Helen

Akagera Adventure!

Giraffes in the park

Helen & Sarah

Adorable pups growing

Children gather for pre lunch handwashing

Muddy roads

Muddy Keens

Kitchen garden

Sunday with CSA orders

Signwriters

Naomi, Florence and Anunciata preparing flowers

New composting toilet

Julie with turkeys

Thanksgiving Menu

Today's list

Julie & Aline

2011-10-30T02:59:00.000-07:00

Connecting. . .

The genocide permeates the psyche of this country and the trauma will linger for decades. Many survivors have lost many or all family members. As a result of everyone’s losses and traumas, “new” families evolve and grow. GHI has become an extended family unit for all the staff which is very heartening to witness and feel their care and connection for/with each other. It is also a remarkable testament to Julie and Brad’s leadership which certainly cultivates this phenomenon. It’s truly special to be engaged with such a dynamic and loving group.

This past week Alli and I helped Anathalie launch another women’s group in the community of Gikomera, as well as had a second meeting with the Rubungo mamas (for one woman she left home at 0500 to attend). Once again we were floored and moved by the responsiveness and the openness of the women. In the Rubungo group we asked about a positive event in their lives since the last meeting. One woman shared that her husband was perplexed that she had returned after last time without any goods (eg Plumpy nut), but she explained she had instead gained a “transformed” self. She was now stronger and a better person who would have much more patience and understanding and less anger with the children as a result of this time with the other women. He apparently realised the benefits and supports her attendance. This was a huge step for this woman.

In the new group, when the idea to have a support group (without children) was presented the response was overwhelmingly positive. On Thursday we returned and the group of twelve mamas gathered and shared. It is amazing to think that most had no idea that others in their midst have similar problems. It was certainly powerful to witness the weeping around the circle as each took turns sharing their testimonies. Gender based violence, rejection, homelessness were all common themes. Anathalie’s expertise and innate compassion, as well as being a genocide survivor, prove to be vital elements as she facilitates the group skillfully.

Please consider a donation to GHI …any amount helps.

click here for:
GHI
Gardens for Health International
9 Avon Street
Cambridge, MA 02138

GHI is a US based 501 (c)(3) non-profit organization.
Your donation is tax-deductible.
Please email GHI with any questions: info@gardensforhealth.org

Connections within my own life have intersected here three times this past week. The first, was meeting Sam, a Global Health Fellow (GHF) friend of Aaron’s, the GHI GHF. Our second meeting last week revealed we were both from Maine and after a minute the penny dropped and I realized that he was Ian and Annie’s classmate at Sheepscot Valley Children’s House. I hadn’t seen him since he was 9! Another connection was with a visiting journalist writer…turns out she is a friend of my niece’s from Connecticut and the third last night was meeting a woman who is getting her PhD from James Cook University in Townsville who knows friends there. “Small world” connections abound!

GHI is hosting the 2nd annual Thanksgiving community feast on 11/11/11. Last year about 500 attended and this year we anticipate about 750. It should be amazing, not only the event, but the process of preparation in the next two weeks.

Helen

Garden jumpers

Mamma with chicken and soap

Mammas at cooking demo

Team work

Helen & Sam Whittemore
meet again after 17 years

2011-10-26T14:28:00.000-07:00

Just a few photos. . .

Naomi and Aline

Lake Kivu view from One Acre Fund residence

Jay's last house supper

Florence and Kevina

Children on the morning walk to the office

Team in the garden

2011-10-20T23:38:00.000-07:00

Soaking in the surrounding goodness…

Another week flies by… as I write from my internet perch (usually a five-bar zone!) on the verandah outside my bedroom, the dawn chorus (incredible birds here) has begun. The sky has turned from pinky to brilliant orange and the noises of our bucolic neighbourhood begin. It is interesting that crowing roosters seem to be a rarity. We are getting a bit more settled into the new residence and getting ‘systems’ organized. With eight of us living here now, it’s wonderful to gather around a meal at the end of the day.

One of the highlights of this week has been helping getting a Mammas’ weekly support group launched. Alli and I have been planning this, with a few obstacles, such as finding an available translator/facilitator. Amazingly, we had Anathalie, a young woman of 28 with good English skills and a degree in clinical psychology, appear on our horizon. The first two-hour session was held on the farm platform and proved to be extremely moving for all of us. Here are some of their testimonials during the lunch afterwards:

"This is the first time in my life that anyone
has ever cared to ask how I am."

"It touches my heart, my heart is clear. To have
people care for me and others makes me feel good."

"When I first came here I did not have peace, I felt I was
the poorest. But then I hear that there are many problems
with people and we can talk about them, it gives me peace."

"We did not know what to expect today but we trust you
because you want to help our children… so we came."

Next week will be the first week of GHI’s Community Supported Agriculture (CSA) program. Crates will be filled from produce from the GHI gardens and surplus from our local cooperatives to supply US Embassy staff who do not want to go the open air markets or the slick Nakumatt supermarket. It should be a win-win-win situation.

Some random observations:

The horrors of the genocide are still very fresh in peoples’ psyches and easily triggered. (This reads like such a glib statement, but I can’t even begin to write about their trauma.)
Two people on staff have shared part of their experiences. It is just impossible to fathom the impact of 800,000 people being murdered in four months in this tiny country. This week, one of the GHI staff, bumped into a friend in town who he thought had been killed. Their reunion after 17 years moved everyone around to tears.
Plastic bags are illegal here. This is announced on the plane prior to arrival into Kigali, “All purchases from Duty Free have to be put into carry-on baggage and plastic bags left on the aircraft.” It is so refreshing to see MUCH less litter about as a result.
President Kagame drives himself in a black Suburban with tinted windows with four vehicles accompanying him (two front and back). Apparently he likes to be in control at all times. Sightings are frequent.
Thatch roofs have been outlawed within the last year and tin has been mandated.
The news of the advancements with the malaria vaccine were met with great cheers, a moment to remember.

This weekend we are headed to Lake Kivu for an excursion which will be fun to see another district of Rwanda.

Helen

Helen in her 'internet perch'

GHI Staff

GHI gardens

Mamma group

Women on platform

Women in field

Aline & Cedric

Solange, Helen and Brad

Thanks to Jay Simpson for two photos; one of the women
on the platform and the two women talking in the grass.

2011-10-15T23:09:00.000-07:00

Settling in…

I have finally had the planets align for getting this first Rwandan posting off; time, internet connectivity, electricity and a functioning computer! As I write there are flocks of lovely, colorful finches feasting on a myriad of dead flying termites. These termites are also harvested by local people for delectable treats and extra protein.

This first week has really been a process of getting acquainted, oriented and settled to the people, place and routine of Gardens for Health International (GHI). Unfortunately, I managed to be struck with a cold/flu from travel which kept me in a bit of a fog bound state for a couple of days, but it is great to be feeling well again. As a result of spending a little more time horizontal than usual, I read Left to Tell: Discovering God amidst the Rwandan Holocaust by Immaculee Ilibagiza, which is a very compelling survival story and gave me further insights into the atrocities of the genocide.

I arrived in Kigali October 6th (on time!) and was met by the fantastic welcoming committee comprised of Brad (nursing colleague/friend from time in Burundi), Aaron a Global Health Fellow here for the year), Solange ( translator), Sunday (translator) and Emmanuel (driver). They were heroic making it, considering a simultaneous hailstorm resulting in local flooding and gridlock traffic. The general chaos was exacerbated by this also being moving day to the new residence. After walking the final mile due to the very boggy and slippery road, it was wonderful to be welcomed by Julie, the country director, who had been preparing and “cozying” the house.

The new residence is a lovely 35 minute walk from the Gardens office/house, a good chance to get a bit of exercise, contemplate the day ahead and practice my very limited abilities of Kinyarwanda. Upon arrival at the gardens, it is wonderful to be greeted by the staff. The place really has the atmosphere of a large harmonious and loving family. Everyone seems very happy and dedicated to their work. Lunchtime is a highlight with a large plate of fresh food for all the workers.

We have been going out into the community to do malnutrition assessments on children. The really severe cases get referred to the district hospital, otherwise they get referred into the government program to receive Plumpy Nut supplementation and then get enrolled into GHI. GHI provides agricultural support with plants and fruit trees, as well as home visits by agricultural field officers. There is a also a four month health education program for the parents (99% mamas) which is taught by three GHI staff (Claire, Naomi and Anunciata, known affectionately as the “Three Mamas”, trained and taught by Brad).

The trainings for the community mamas coincide with their weekly visits to the local health centers to pick up their Plumpy Nut. It is truly wonderful to see the “Three Mamas” interact with the community mamas and share their personal testimonials, illustrating the concept of empowerment at its best. The trainings (designed by Brad) are excellent; beginning with yoga breathing and stretching, followed by terrific skits which personify the lesson (family planning this week). They captivate their audience and prompt many questions and general discussion amongst the mamas. Part of my work here will be to help Brad develop these trainings.

Alli (another volunteer) and I are also working together on psychosocial aspects of care and support/trainings. I feel very fortunate to be working and living with such a motivated and dynamic group of ‘twenty-somethings’ from the USA. It gives me hope for the future of humanity and the planet. There is much more to write, but I will sign off for now.

Hopefully the accompanying photos will give more of a sense of the goings on here. Helen

Helen walks to office

View of GHI office far left

Gardens for Health headquarters

Flower gardens

Julie and Cedric at plant nursery

Brad with Solange and Mamas

Helen with Solange and Mamas

Lunch

Helen with babes

Helen and Alli weighing

Mama with 3.2kg 7 month old

Claire and Naomi

Claire doing 1 on 1 consult

Claire and Naomi start with yoga

Ngiryi mamas being trained

Moto transport

Alli and Helen

Mama receiving plants

Child

Puppy love

Boy with harvested termites

Moringa & Mango

Helen finds the '5-bar spot' for the internet

2011-10-03T15:15:00.000-07:00

Rwanda Bound. . .

Since my last entry in November 2010, I have attempted to re-frame the question “What is the meaning of life?” to “How to live one’s life with meaning?”! It’s been a good stint of self-reflection and opportunities to help friends and loved ones dealing with their transitions with moving, marriage, illness, and death. It has been a time to widen my horizons and keep my aging brain stimulated with more learning. I have been a participant in The Harvard Program in Refugee Trauma hprt-cambridge.org, obtained Wilderness First Responder certification wildmed.com and attended the Summer Institute training at the Dougy Center, The National Center for Grieving Children & Families dougy.org in Portland, Oregon.

A “Healing Environments” video assignment for the Harvard program was particularly challenging, but ultimately provided me with a sense of fulfillment as I was able to synthesize some of my overseas work experiences to date. Reviewing thousands of photos of my own and my colleagues, brought back many memories and stories, but most of all cemented the reality that it has been an absolute privilege to embrace the humanity and uniqueness of many extraordinary individuals and communities across the globe. Here’s the video link: http://www.youtube.com/watch?v=cPGeobEV5qY. It’s about seven minutes.

I am departing for Kigali, Rwanda on October 5th to work with an organization called Gardens for Health International gardensforhealth.org. (The new and updated website is to be launched by mid-October.) I will be there for about two months and then return to Australia. To quote the website, “The Gardens for Health program is designed to enhance long-term food security, decrease malnutrition, foster economic development, and support effective HIV/AIDS care, and treatment.” The program comprises four integrated components: (1) Cooperative formation & land advocacy. (2) Inputs for community & home gardens. (3) Agriculture & nutrition training. (4) Income generation through agribusiness. Some of my roles which have been outlined in advance of my arrival are to assist with curriculum development …training the trainers; protocol development to integrate home based agricultural assistance into the prevention and treatment of malnutrition; integrating psychological first aid practices and other staff trainings.

Congratulations to Emma Clippinger, 25, co-Founder and Executive Director of Gardens for Health International based in Boston, who has recently been named a Bluhm/Helfand Social Innovation Fellow and will be a speaker at the Chicago Ideas Week chicagoideas.com on October 10th. Over the past three years Gardens for Health International has received numerous accolades, including an Echoing Green Fellowship, and the grand prize in the Dell Social Innovation Competition, JP Morgan Good Venture Competition and Ashoka/Staples Youth Social Entrepreneur Competition. I am very excited anticipating the opportunity to work with a very dynamic and motivated group of under 30s from the USA including nurse extraordinaire Brad Snyder, whom I worked with in Burundi. Most of all I feel honored to be working with Rwandans who have undoubtedly endured so much in their lives. As Richard Mollica MD, the Director of the Harvard Program in Refugee Trauma writes in his book Healing Invisible Wounds, the goal is to help the individual create a new story, and that “The new story that emerges is no longer a story about powerlessness about losing the world and being totally dominated by someone else’s reality … it becomes a story … of survival and recovery.”

Postcript:
Cultivate Hope.
Please consider a donation to Gardens for Health through the website: http://www.gardensforhealth.org/support.php

Thank you so much, Helen

Gardens for Health Rwanda Staff

Helen & Emma in Boston

2010-11-12T13:58:00.000-08:00

Orvieto, Italy

Helen left Haiti just before Tropical Storm Tomas was due to arrive in Haiti and is now in Orvieto, Italy for a couple weeks taking part in a Harvard Certificate Program in Global Mental Health; Refugee Trauma and Recovery. She will be returning to Australia on Nov. 26th.

2010-10-31T12:44:00.000-07:00

Life in the time of cholera. . .

Ten days ago I was working in a mobile clinic in a local neighbourhood in the “rubble zone” when the news first surfaced about a cholera outbreak about 60km. north of Port-au-Prince. Since then the “regular” routine of J/P HRO has been dramatically affected.

Cholera is a bacterial disease transmitted by the fecal-oral route. High population density areas such as refugee camps are especially vulnerable and the potential for cholera spreading to epidemic proportions rapidly is high unless control measures are taken. Cholera presents with sudden profuse painless watery stools, often accompanied by vomiting. Dehydration occurs rapidly and can be fatal if not quickly corrected. Clean water supplies and good hygiene (especially vigilant hand washing) are essential in control.

Under the leadership of JP’s Sean Penn (executive director) and Alastair Lamb (country director) there has been a very impressive proactive stance dealing with the possibility of a cholera epidemic hitting the Petionville Camp of 55,000 people. With the help of contracted staff and volunteers a cholera control strategy and cholera treatment center was established rapidly. “Prepare for the worst and hope for the best” has been exemplified to the fullest degree.

Last Saturday I was sent into the epicenter of the outbreak to the hospital in Saint-Marc’s with Lincoln Moore, JP’s Information Officer, nine workers and a translator. (I was the only woman and the oldest by a couple of decades.) Part of my role was to observe and learn from the set up in that hospital (which had been hit broadside with minimal warning of the outbreak), help oversee the training of the workers for cleaning and infection control, as well as report back to J/P with general and specific recommendations for the cholera control strategy.

We departed after dark on Saturday with Junior as driver/security guard at the wheel. Upon arrival at Saint-Marc’s we made contact with Partners in Health staff and worked out a plan for the morning's work to commence. Unfortunately there was no available accommodation anywhere and after some negotiations we managed to be horizontal in a hotel lobby for a few hours.

When we arrived after dawn at the hospital the scene was certainly something I have never witnessed. The mortality count was about 250 as of that morning. Outside in the hospital parking area and inside all the wards hundreds of people were on cots and on the floor/ground being cared for by family members (a 1:1 ratio). Many of those dead had no family. The sounds of retching and wailing pierced through the sweltering heat, as well as the smell of death and diarrhea (later bleach and burning medical waste was added to the mix). Bedpans were overflowing and flies abounded. Later I will have to write a full account of all the images which struck me that day.

After being trained by a MSF Water/Sanitation officer our cleaning crew (usually construction workers) set to work with their mops and buckets. They worked extremely hard in challenging conditions for 8 hours and received many accolades from the hospital administration. Precautions for their own safety were reinforced continuously. They have been there every day this week in force and have made a considerable contribution in controlling the spread of cholera.

The rest of the week I have been working at the JP clinic/hospital in triage and so far there have been no cases of cholera reported in the camp. Confirmed cases and one death have been reported in Port-au-Prince closer to the camp. Monday and Tuesday, November 1st and 2nd, is the traditional Haitian Day of the Dead celebrations. Due to the earthquake, this year’s gatherings will be extremely poignant and also presents the possibility of cholera spreading as people come from rural areas in the city. Security is especially high for the JP community. The fuse of a time bomb is burning.

Now there’s also another glitch on the horizon…Hurricane Tomas. How much more trauma and stress can this country bear?

Helen

J/P HRO crew heading to Saint Marc cholera clean up training.

Junior

Helen with J/P worker Agincourt

Cholera Treatment Centre

J/P HRO camp from the air.

2010-10-21T13:45:00.000-07:00

Heaven & Hell. . .

Last night I had the most heavenly dreams which feel like an antidote to the hell I witness during the day. I dreamt that Robert and I were celebrating our 25th anniversary and Robert’s 60^thbirthday with a massive gathering of ALL our friends and family (including those who have died) and we were all in the Pacific Ocean or on the beach in a Big Sur bodysurfing with thousands of seals or bobbing with beguiling sea otters. Everyone was so happy and having so much fun together. It was absolute bliss. . .

In stark contrast, during the past two days I have had the opportunity to walk down into the camp/tent city to work with community health agents from J/P HRO. Despite nine months having passed since the earthquake, about 50,000 people are still crammed cheek to jowl on what used to be a golf course. As I walk in the sweltering heat past ‘houses’ (which have been upgraded from random tarps and boxes to 2x4 structures with well secured heavy duty tarps by teams of JP workers) on sand bags lining drainage ditches, I see plenty of astounding images.

However, no photos are allowed. A few word pictures will have to suffice: Small children playing with a piece of short string and a small plastic bag as a makeshift kite; women setting up their beauty parlors for the day; makeshift storefronts selling services of recharging cell phones; plenty of people just sitting on their stoops. . .

There’s a market “street” which has been established now. During the nightly torrential downpours I think of all those people in the camp as I lay dry, safe, snug and clean in my cosy tent.

J/P provides medical care, rebuilding and demolition and rubble clearing and community services, including a school which opened this week for the camp. Other aid agencies in the camp include Save the Children, OXFAM, IMC, Handicap International and the UN. All these entities have obviously improved the quality of life considerably for this population, but it is overwhelming how much more work there is to do.

Helen

Cholera Update:

This Oct. 25th New York Times article is a pretty good description of the scene at St-Marc, one of the areas affected by the cholera outbreak: Amid Cholera Outbreak in Haiti, Fear and Misery by Deborah Sontag

Also, have a look at this CNN interview with Sean Penn, co-founder of J/P HRO.

2010-09-18T20:18:00.000-07:00

Taking more plunges. . .

“The cure for anything is salt water - sweat, tears, or the sea.” Isak Dinesen

I have spent the past few months here on the home front in Maine collecting my wits and reevaluating my goals and taking Isak Dinesen’s words to heart.

After I departed Kigutu at the end of April, I went to Rwanda with Will Marsh, the VHW agronomist, on a fascinating and fun six day trip. Seeing the mountain gorillas in the wild was definitely a life highlight. The night before I departed for the USA, I received an email from the VHW administration in NYC saying that I would not be able to return to Kigutu as I had hoped. There has never been any follow up or explanation of why, which I find very disturbing after all the time, commitment and sacrifice I poured into VHW, an organization serving people whom I care about deeply. I felt derailed. Thanks to the loving support of family, friends and a healing environment in the midst of Maine’s “best summah evah”, I am once again on track and almost ready to head off again on another odyssey of service…this time to Haiti to work with J/P HRO near Port au Prince. Have a look at their website at: jphro.org.

People routinely ask me about where my next adventure will take me which makes me feel slightly awkward. Perhaps they don’t mean it, but “adventure” seems to aggrandize my experiences and shift the emphasis away from the intentions of voluntary work and service. Recently I came across these words from John Amatt the organizer of Canada’s first successful expedition to Mount Everest’s summit. I like his description and it seems a great way to define the word ‘adventure’ and it fits into the paradigm I hope to achieve in life.

“Adventure isn’t hanging on a rope off the side of a mountain. Adventure is an attitude that we must apply to the day-to-day obstacles of life --facing new challenges, seizing new opportunities, testing our resources against the unknown and in the process, discovering our unique potential.”

I will also be taking another plunge into academia. After almost a month in Haiti, I will go to Orvieto, Italy in Umbria, to be a student participant in Harvard’s Global Mental Health: Refugee Trauma and Recovery Certificate Program for a fortnight of face-to-face lecture, discussion and collaboration followed by five months of work online. I hope that this setting will help synthesize my work experiences and expand my scope of practice. It will also increase my network of colleagues which will help me continue with my quest to do my small bit to improve the lives of others less fortunate than me. Being in Orvieto after Haiti will certainly be quite the juxtaposition.

As the Fall Equinox approaches and I look back on this extraordinary summer another quote from Dinesen helps me keep perspective.

“Difficult times have helped me to understand better than before, how infinitely rich and beautiful life is in every way, and that so many things that one goes worrying about are of no importance whatsoever...”

Helen

Diving into the Damariscotta River

Swimming to Bennett's Neck

With the gorillas in Rwanda

2010-04-23T12:55:00.000-07:00

“Tuzosubira, Kigutu!”. . .
(See you later, Kigutu!)

This morning I watched as the pink dawn evolved into a spectacular display of cloud formations across Lake Tanganyika over the Congo. I took some deep breaths, soaking in the sights and sounds of Kigutu waking up, enough to last me awhile. It’s my last day in Kigutu. My duffel is packed and I am ready for some travels. I have been progressing through the goodbyes and am now looking ahead to reunions with everyone at home.

Highlights of the week were seeing many of the adorable children who have been discharged from the in-patient malnutrition program, returning for follow up visits. It is EXTREMELY gratifying to witness their progress. The photos tell the story. One 3 year old girl ran up to me with arms outstretched, exclaiming “Mama Muzungu” (“White Mother”)…what more could one ask for?

On Wednesday, Brad and I made a home visit accompanied by Gerard and our steadfast guard Desiree to a 7 year old girl who had been raped by a neighbor last week. She was supposed to return for follow up on Tuesday with her father and we were very concerned. Apparently the man who assaulted her (as well as threatening her with a machete if she screamed for help) believed that having sex with a virgin would cure HIV. Horrific. Amazingly, we found her with her mother and siblings. She seemed to be doing OK and is taking the antiretrovirals as prescribed. The man is in prison and will be brought to trial. Today her father came to VHW to talk and thank us for the home visit since he was not at home when were there. It is gratifying that the family knows that the traumas of the girl’s experience can be counterbalanced with support and concern.

Last night we had the collective April birthday party for people (Peter IT, Mandela, Pascal and me) which was also a combined farewell soiree too. We had a chicken feast, drinks and plenty of dancing to follow with a good dose of tears and laughter too. Now that I am a year older, I figured it was about time for me to kill a chicken, so I did! I will miss my Kigutu “family” very much. It’s an amazing group of talented, dedicated people here and I feel absolutely privileged to have been part of their team.

“See you later, Kigutu and friends”…it’s NOT goodbye, as I feel very committed to the people and the VHW program and certainly hope to return.
Now I am off to Rwanda for a few days.

Helen

Bukuru and Toyi

Mana at admission

Mana on discharge day

Bea side 25-2-2010

Bea returns for follow up 3kgs. gained!

Fabrice

Fabrice 2

Fabiola

Brad on home visit walk

Chicken ready for the pot...almost

Beheaded chicken

Kigutu friends

Maombi savors chicken

Achel, Ferdinand and Maombi

Frederick and Helen

Dancing

Helen in the misty mountains

2010-04-17T14:09:00.000-07:00

Big week in Kigutu. . .

The past week here in Kigutu has been action packed. The long awaited day for the official opening of the Community Centre was on April 9th. A predawn downpour freshened up the VHW campus and all the hard work done by the landscaping crew and the community women over the past few weeks was pristine. Everything looked vibrant and lovely under the blue skies.

The Kigutu drummers led by Peter and Mandela were spectacular and offset by Claudine’s girls’ singing group. They provided a wonderful backdrop as the VIP guests from Bujumbura arrived. Then per Burundian tradition the community members (perhaps 200) gathered and filed into the driveway and to the Centre in a grand procession singing, dancing and carrying large loads of food and drink wrapped in banana leaves on their heads. It was a sight to behold and certainly very special to feel the energy and excitement.

The morning continued with speeches, more performances and drumming. The youngest drummers (absolutely adorable) who can barely reach the top of the drum, drew much applause. In the cool afternoon breezes and under the shady trees people relaxed on the lawns and soaked up the goodness of all their efforts. Many gathered to watch photos and videos of VHW in the evening to top off the big day.

This week VHW also received a delivery of rice, soya flour and oil from the World Food Programme which will assist with the malnutrition program. Another delivery for the HIV patients will be arriving soon. All these “macro” events are strengthening VHW’s impact considerably.

VHW had a landmark day yesterday when a new state of the art portable CD4 machine was delivered by Felicia Price and her entourage from the Clinton Foundation. Accurate monitoring of CD4+ T lymphocyte levels in HIV-infected individuals is a critical element for the use of anti-retroviral drugs (ARVs) as it guides physicians in determining when to begin drug treatment and is a key measure of the effectiveness of that therapy. Staff members were trained in how to use the machine and we are all thrilled to be on the cutting edge of HIV care here in Burundi.

In the midst of all these grand events for the program, I have been touched by the “micro” events too:

Receiving the very special present of 5 eggs from a patient who had walked far for a rendezvous appointment.

Witnessing previously severely malnourished children be discharged with strength and vigor after 10-14 days of treatment. It’s like watching a slumped over plant receive water and fertilizer, stand straight and begin to grow and flourish. The children literally come to life and become engaged individuals.

Watching another amazing sunset from the water tower with Hilarie.

Giving and receiving a daily hug from Anne, our wise and wonderful head janitor.

Teaching people how to stand on a scale for the first time.

Teaching people how to open a door with a door knob.

These experiences give me profound satisfaction and fulfillment. I will miss Kigutu and hold all these memories closely. Departing next week will certainly be a bittersweet time.

Helen

Community Center on Opening Day

VHW on April 9

Women arriving at Center

Little Drummer Boy

Brad, Gerard, Cory, Celestine
Helen, Will, Elvis on April 9

Peter and Mandela resting

Community women after opening

Claudine's singers

Accompagnateur Daphrose and Helen

Melino drumming at opening

Bazile getting set to perform

CD4 machine arrives in Kigutu

CD4 Training

Will and crew move WFP food

Gift of eggs

Heading home

Hilarie and Helen

Sunset April 14

Alex departs

Helen and Anne

Scale with well worn feet

Eyelash envy

2010-04-12T15:05:00.000-07:00

In the grip of igituntu . . .

Marie (not her real name), age 45 weighing 35 kg, is from Rumonge and came to VHW on March 23rd for consultation. She had been experiencing cough, weight loss and dyspnea (shortness of breath) for several months. Dr. Melino suspecting TB (igituntu in Kirundi), referred her to Rumonge Hospital for a chest x-ray and some lab work since VHW does not have these facilities yet.

Today she returned with the x-ray and the lab results. The x-ray is impressive…revealing TB with disseminated “opacities” in all lobes. Miliary TB is apparent in the upper left lobe with pleural effusion. We still await results of sputum tests. She was admitted today, registered in the TB program and began the rifampicin, isoniazid and pyrazinamide treatment regimen.

Seven months ago when her cough became persistent Marie went to the traditional healer in Gatete who specializes in the “uvula disease”. He cut her uvula and epiglottis at that time. Her cough did not subside and now she has to constantly clear her throat since she does not have her epiglottis. She went to the local health center twice where she was told she had malaria both times. After treatment she continued to feel terrible and came to VHW. When asked how she heard of VHW, she replied,” This clinic is known everywhere and many people told me to come.”

Yesterday she walked from Rumonge to Mugara (14 km), spent the night and walked this morning from Mugara to Kigutu (6kms. uphill). Despite it being a Burundian public holiday and arriving at 0900, she was # 57 in the patient queue. After triage assessments she was first in to see Dr. Melino.

Her husband died around 2000 in a war related incident. She has had four children, two who have died at age 6 and age 3. Right now she is concerned because she has left her 12 year old daughter and 10 year old son at home to fend for themselves. She is also worried because her two room mud house (one room for sleeping and one for cooking) just has a grass roof and it will be very vulnerable during these heavy rains. She wants to get her children to VHW as she states her daughter is coughing and has “untreated shoe disease”. Marie realises that taking her to the traditional healer might not be the best choice.

She has “no fear” about being at VHW. Meanwhile we will try to track down her children for screening and assessment. There must also be communication with the traditional healer regarding the dangers of untreated TB.

Helen

Marie with TB

TB lung x-ray

2010-04-06T13:08:00.000-07:00

Running for Peace. . .

The long distance runner is a special type of person, manifesting extreme dedication with incredible mental fortitude and physical endurance. At Village Health Works (VHW) we have two marathon runners in our midst who have these characteristics. Peter Ndikumana and Nestor “Mandela” Nimbona are currently training hard in the Kigutu “hills” for their first marathon, The International Peace Marathon in Kigali, Rwanda on May 23, 2010.

Peter “IT”, 32, has been employed at VHW since September 2008 and wears several hats. He is involved with information technology (hence the “IT” added to his name), manages inventory control, helps maintain the solar panels and the battery storage. He has been a drummer since childhood and now co-leads the Kigutu Drummers with Mandela. He is eager to fulfill his life-long dream to run in a marathon, as running has always been a passion for him. He loves the challenge of training and wants to see how he “measures up” in a competitive field. He’s excited to run for peace and justice.

Mandela, 31, a VHW employee for three years, has been working part time in the kitchen as well as being in charge of laundry services. He has been drumming since he was eight years old and has been abroad to France and Japan on tour with a professional Burundian troupe. When his group greeted Nelson Mandela’s plane on a visit to Burundi, Nelson Mandela came up to him and took his imirisho (sticks) and began drumming. Mandela was so impressed and inspired by him, as well as having a similar Christian name (Nelson/Nestor), he decided to take “Mandela” as an additional name.

Both Peter and Mandela are terrific role models for the children of Kigutu, leading and teaching the drumming circles three afternoons a week. When they aren’t working or drumming, they are in the hills of Kigutu preparing for the marathon in Kigali. Everyone from Kigutu and VHW friends from around the world will be cheering them on.

Helen

Peter and Mandela training

Mandela and Peter

Peter drumming

Mandela airborne

Mandela doing laundry

Peter in depot

Mandela and Peter IT

Verdant Kigutu hills

2010-04-03T13:36:00.000-07:00

Gratitude & Renewed Perspectives. . .

Last weekend and early into the week I was all-overish (adj. Feeling an undefined sense of unwell that extends to the whole body) and missed a few meals which meant by the time I returned to the communal table I was definitely avidulous (adj. somewhat greedy). Agerasia (n. a lack of the signs of old age) is a quality that I generally pride myself for, but being horizontal for more time than usual had its agathokakological (adj. composed of good and evil) effects…having some quality time with my Kindle (good) and also feeling older than I really am (”evil”).

I have been immersed in a wide variety of reading (Teddy Kennedy’s memoirs True Compass, Baking Cakes in Kigali, Richard Russo’s That Old Cape Magic and now Reading the OED). I have often thought that if I was imprisoned or stuck someplace for a year and given the choice of one book, I would choose the Oxford English Dictionary. Ammon Shea has taken it upon himself to do just this. I find the book pretty fascinating and as you can see I am trying to include some “As” to expand my vocabulary and exercise the gray matter.

While I was experiencing the “cellular ache” of whatever it was I had, dreaming of luxuriating in a hot bath, I quickly roused myself out of such self-indulgent fantasies and imagined the challenges facing all of the patients who come here to VHW seeking treatment. I was pulled back into my fortunate reality of a cosy bed and a roof over my head as the rain pelted down “hippos and elephants”. I thought of the many people who walk for hours through the pouring rain feeling terrible (and hungry!) often carrying their ill children, doing their best to survive on practically nothing. Everyone has their own sort of pain and suffering, but wow, I felt so spoiled. I came away from my reveries with a renewed sense of perspective and compassion for these significantly impoverished people who I have the privilege to assist on a daily basis.

We delivered one patient home via vehicle last week as she was too weak to make the journey on foot. Her health has deteriorated due to chronic diseases and her possessions were in a small wrapped piece of fabric. Her house was a basic mud house with corrugated tin roof right on the busy tarmac thoroughfare. One could easily think she wouldn’t have any reason in the world to smile, but her delight with her homecoming certainly blew that idea out of the water. She was radiant, despite her emaciation, and just so happy to be HOME with her family! Witnessing the essence of her life, love and family, and receiving her gratitude was very moving.

Despite not speaking Kirundi, I understand more these days, but still feel severely handicapped by not being able to converse directly with all these lovely people.

Walking to “downtown” Kigutu at dusk, I feel quite integrated into this small community on the top of a hill. Listening to the drumming, watching the local soccer game and hanging out a bit at the local boutique greeting VHW staff as they head home. It’s a special place indeed. How lucky I am for these friendships I have made here.

Now I can begin to feel the tide turning as I prepare for reentry into my “other world”. I am really looking forward to the reconnections with family and friends, but also ready to pack a lot into the last three weeks here.

Helen

Homecoming

Helen on home visit

Patient home

Assisting patient for transport from home

Arm

Anna peaking around curtain

Mother with TB with one her
twins who both have malaria

Didace working on huge stump

Bazile

Road to Kigutu

Malnutrition ward

Verdant hills

2010-03-27T00:36:00.000-07:00

Humbling life stories
& miraculous Moringa. . .

The week has zipped by. The hourglass sand is emptying faster as I enter into the last month of this stint.

The standard fare of beans and rice is excellent, but gets a tiny bit monotonous after two and a half months. For a variety of reasons (including celebrating the passage of health reform in the USA), it was decided that last Monday was the day to have impene (goat) for dinner. After clinic time there was major deliberation as to which one would be served. Brad was all set with the knife, but in the end Elvis did the deed. Dinner was a festive occasion!

A woman hobbled into the clinic barefoot with a large walking stick and a baby on her back two days ago. She reeked with the quintessential smell of infection and necrotic tissue. Brad examined her and discovered that her right breast was bandaged and saturated with a foul, green discharge covering a ragged, deep crater eroding most of the breast. Her 8 month old daughter, Misago (meaning the 11th child), is severely malnourished. They were “fast tracked” through triage and admitted.

Getting her and the baby “settled” took a bit of time; cleaning them, changing the breast dressing, initiating antibiotics, pain medication and vitamins for the mother and getting the baby begun on the standard malnutrition protocol of medications/vitamins and F-75 milk supplement. It seems as though she has breast cancer, requiring the need for surgery and X-rays of her hip for evaluation of possible metastatic bone cancer, neither of which we can provide here at VHW. Right now we will fortify her and get the infection under control and then refer her onwards.

Thanks to the help of Gerard as my translator, I have been able to get a quite in-depth history and hear some of her life story (as well as several other patients). She is 42 and the mother of 11 children. Her husband left her last year. Two children have died and she has left 4 children home alone with a nine year old in charge. She walked about 50 miles in the torrential downpours over two days to get here. Her tenacity, resilience and acceptance of suffering as her status quo is certainly humbling. I feel privileged to be involved in her care, helping her with her right to health care and elevating her dignity.

I have done more home visits this week, dovetailed with Will’s visits to home gardens in Kigutu. I love these times. We are really beginning to integrate the food security program with clinical care and nutrition for the patients and staff with highly nutritious Moringa which is very exciting. Moringa oleifera is a phenomenal “vegetable tree” which is grown on site. It provides huge amounts of beta-carotene, Vitamin C, protein (all amino acids), iron and potassium. The leaves can be cooked like spinach or they can be dried and crushed into a powder and added to cooked foods.
Will has given talks to the mothers in the malnutrition ward about Moringa and we are beginning to give it to the children. This is especially timely due to the cutbacks from UNICEF with the Plumpy Nut supplies. We are now sending patients home with Moringa powder and seedlings too. It is definitely possible that much malnutrition and disease can be prevented through the use of Moringa. Check out www.treesforlife.org to read more about it.

Two staff members, Peter and Mandela, are entering the International Peace Marathon in Kigali in May. It’s terrific to think that VHW, Kigutu and Burundi will be represented by these two remarkable athletes. I will be cheering them on from overseas.

There is a tradition here now at VHW that on the last Thursday on the month we have a soiree for all the staff to celebrate the birthdays which fall within that month. Last night we celebrated Evariste, one of our drivers. It was a fun night for everyone to gather, unwind and dance. This is definitely a special group of people for work and play!

Helen

Impene preparations

Impene ready for the fire

D and Misajo

Bosco and Will home gardens

Will and Bosco giving talk about moringa

Will with moringa powder for severely anemic boy

Mothers going home with moringa seedlings

Sisters

Mandela and Ferdinand doing laundry

Kigutu family home visit

Brad and Melino

Barack and Brad

Dancing

Helen with Hussein and Germaine

Another amazing sunset over the Congo

2010-03-22T14:02:00.000-07:00

Amahoro, mwiriwe. . .

The torrential seasonal rains each day (Melino says hippos and elephants vs. cats and dogs) have been producing a lot of standing water everywhere, perfect habitat for mosquito larvae. Adults and children with cases of severe malaria continue to represent a huge portion of the patients admitted at VHW.

Last Monday Peter, Will, Brad and I walked to a neighboring village, Kirungu, for community outreach. We were accompanied by our armed guard Desiree (who had no idea he was going to be following the muzungus on a steady hike for four hours!). Many citizens had large pits from digging the clay for bricks right next to their houses half filled with rain water. No wonder malaria is rampant. We did our best to provide some education about the dangers of malaria. Luckily quinine is still a successful treatment and most people turn the corner fairly rapidly. Bed nets need to be distributed too. Over the weekend we had four malaria patients delivered by stretcher. It always amazes me to think of these people getting carried such far distances, lugged up and down these slippery tracks.

It was great to be out in the village talking to people (mostly women) about the access to health care in Kigutu. They are eager to attend the planned teaching sessions on home gardens and nutrition. They also seem eager to discuss family planning, though they were inhibited by the presence of children and men.

Preventative care, which is a bit of an alien concept, especially for children, was discussed. It was very gratifying that a father brought his healthy (utterly adorable too) twins in for “well child” checks on Friday after meeting them earlier in the week in Kirungu. We will return there soon. Peter is the perfect ambassador and guide.
Later in the week I accompanied our local Kigutu accompagnateur, Cecile, on her before sunset rounds. Seeing people in their regular daily routines vs. in the hospital is very appealing! I love being out and about in the community as people fetch their water from the pump, return home from the fields with full baskets on their heads; children play with balls made out of wadded up plastic bags and string and boys herding their cows home.

Many people know me now (and even if they don’t), there is a continuous litany of the standard greeting “Amahoro, mwiriwe“ (Peace, good afternoon) with firm handshakes as I walk the paths through the banana and cassava plots. It was sublime with spectacular evening Maxfield Parrish light with the background sounds of the drummers practicing and the children singing in the local church.

Cecile took me to a tiny mud hut with a woman in her 70’s (very old for Burundi) with extreme edema and ascites (fluid in her belly) lying on a fresh bed of grass outside her doorway. There were two lambs leaping over her head as she lay in a pool of sunlight. It was a serene image. Later she came to the clinic and Melino did a paracentesis, resulting in the drainage of 5 liters of peritoneal fluid which will make her much more comfortable. I look forward to following up with more home visits and time out in the community.

It was extremely gratifying to finally get a hand washing station with water and soap set up in both wards this past week. It’s certainly basic and simple, but nevertheless quite an achievement. Infection control at its best!

The malnutrition ward has been overflowing. It is so wonderful to see these children morph from frail, withdrawn waifs into plumpy, outgoing little characters over their time here, an average of 2 weeks. The mothers (or often grandmothers) become their own little tribe, forming a sisterhood of mothering as they care for their children. When one departs they all have a clapping sendoff as they walk out the driveway. When a new child is admitted I make a point of introducing the mother and child to the group. It’s a special place with Ada and Floride being the mother hens, keeping the milk supplied and the place clean.

A few of us had a weekend away in Buj. I had a swim in Lake Tanganyika which was a first for me. Brad, Will and Alex learned that eating ice cream, especially in public, is a sign of homosexuality in Burundi… though men holding hands and other public displays of affection aren’t seen as such.

I’m about two thirds of the way through my time…yikes….I feel as though I have barely made a dent in all there is for me to accomplish here on this stint.

Helen

Desiree guard

Adorable twins in Kirungu

Kirungu woman

Kirungu Mother and child

Peter 3

Cecile on rounds

Kigutu woman heading home

Downtown Kigutu

Melino drumming

Claudine's singing group

Hussein and grandma

Malnutrition mothers awaiting Melino

Morning rounds

Marie

Handwashing station by the ward FINALLY

Ice cream eaters

Lake Tanganyika swimmers

Ada, Helen, Floride

Newly admitted family
to malnutrition ward

Raining 'hippos and elephants'

2010-03-15T12:50:00.000-07:00

Daily Rhythms. . .

The week has been a bit of a blur. The days unfold and are remindful of the ocean’s rising and ebbing tides. Every morning the patients pour through the gate towards triage as we are walking to do rounds in the malnutrition ward. It’s a quick assessment for the rest of the day’s “busy-ness”. The high tide peaks around 11:00 and by 5 PM it has ebbed, leaving behind full beds in the overflowing wards, a reduced supply of medications and a weary staff.

A 14 month old baby died over the weekend. She was admitted on Friday with malaria and severe anemia. Getting her fever down from 40.3 C (104.5 F) was challenging. Later she had respiratory distress and succumbed. It’s so sad knowing that a blood transfusion would have probably made the difference between her life and death. There is a severe national shortage of blood in Burundi and transporting patients to Rumonge or Bururi (about an hour away) is problematical. The day that we have blood bank capabilities here in Kigutu will be a quantum leap for VHW’s services.

Several of us had a “Mountains Beyond Mountains” hike on Saturday and did home visits to Clovis (the 4 year old burn patient) as well as to a gentleman who has diabetes and a successfully healed chronic leg ulcer. Clovis’s burn is healing so well. Brad brought back some Vitamin E oil for the final healing process. Upon our arrival his grandmother (who is really his surrogate mother), Liberatie, was working in the fields. Word was sent to her , via the grapevine, that the muzungus had appeared and she came running back with a load on her head. (I hate to think how far she came!) As per Burundian custom, we had to accept her gifts of food for us. As we were about to depart some children appeared with loads of firewood and started running away terrified when they saw us on their home turf. It was probably the first time they had ever seen a muzungu…never mind four of them. Liberatie called them back, laughing hysterically.

Telling time in Burundi is another difference requiring a bit of adaptation for us muzungus. Only daytime is differentiated into hours. We are so close to the Equator here, with the sun rising at 6AM and setting at 6PM, there is hardly any dawn or dusk. 7AM is 1 (rimwe), 8AM is 2 (ibiri), 9AM is 3 (gatatu) and so forth. The months are named according to the flow of the weather changes and patterns. April is “ndamukiza”, meaning “greet them on the other side or “greet them for me”…
since the rivers are flowing at high levels and people are not able to cross, they have to just yell across the water to those on the other side.

The highlight of the week was definitely the return of Bazile and Brad. It’s great to have them both “home”.

Helen

Patients arriving in the morning

Six toes

Helen hiker

Walkers at the top

Boys reading

Walkers with Clovis and family

Helen drinking banana beer

Wood carriers

Helen with Hilarie's auntie

Heading home back down the hill

Clinical staff welcome back Bazile and Brad

2010-03-06T14:06:00.000-08:00

Hard Challenges: Umupfhumu, Hunger and Cutbacks. . .

It was another full-to-the brim week here in Kigutu! There was a veritable tsunami of patients arriving for consultations every day, as predicted, because of the relative lull in the action last week due to the bean planting in the region.

We had a series of patients arrive with infections, liver toxicity and cardiac complications as a result of visits to the umupfhumu (traditional healer). It seems to be embedded into the local culture that the uvula and the epiglottis cause ‘the shoe disease’ and that the xiphoid process (the prominent bony tip at the end of the sternum) causes the bone disease’. The traditional healers are thought to be able to prevent these horrible fates and are the ones to provide the healing via cutting as they “. . know the research”. They are all profess to be ‘experts’ on liver problems and other chronic diseases too. People seem to flock to them and are willing to pay them a lot of money (which they don’t have).

This week we admitted five patients who had serious problems as a result of the umuphumu’s care. There was a three week old baby who weighed three pounds and was not able to swallow any milk or breastfeed due to a uvulectomy the previous week; an 18 year old girl with a tumour on her foot (she had had it for 10 years) who had a severe infection after cutting; a 30 year old man with hepatitis B, with poisoning from herbs as well as an infection post removal of his epiglottis (he also has a chronic cough now trying to keep food and water out of his lungs); a 4 year old girl who is partially deaf as a result of repeated ‘throat cleanings’ and ear damage. She also has rheumatic fever because of the pharyngeal infection post epiglottis removal. Melino did an echocardiogram of her heart and luckily she has no damage. Lastly, a nine year old who has severe cardiac problems due to rheumatic fever (she’d had her epiglottis removed a few years ago.) Who knows how many people are suffering from complications that don’t make it to VHW. Last month we had a man with a severe penis infection due to a visit to the umupfhumu. The high risk of contracting HIV is also terrifying.

Melino has given talks this week to patients and their families as well as the accompagnateurs about the dangers of seeking care from the umufphumu. It’s an ongoing saga in health promotion. During the talks we show the audience our own xiphoid processes (yes, even muzungus have the ‘bone disease’!) to try and educate them that it is normal. It’s a challenge to find the balance of cultural sensitivity to local belief systems and reining in the life threatening practices of the traditional healers.

Two representatives from the World Food Program (WFP) arrived on Monday to speak with and evaluate the eligibility of all the patients in our HIV program regarding receiving food packets. The WFP has had recent cutbacks and now will only be supplying family food packets in Burundi to 5000 people this year compared to 6000 last year. As you can imagine, food and hunger are very touchy subjects and are potentially volatile. The reps stated that they choose to run meetings publicly for complete transparency and social justice. Confidentiality is not an issue. It was a fascinating process to witness and went smoothly.

They began down the list (about 100 people) calling the names one-by-one. Each individual stood or came forward and stated their case. Some were immediately checked off as a ‘pass’ and others not. It was interesting to note how the group got involved in the ‘yes’ and ‘no’ process. For example, one man stood and everyone yelled, “He’s poor, he’s poor!”…and he got a check and not the long cross out line over his name. Another fellow, claimed he was an orphan (one of the criteria for acceptance into the program), despite being an adult. There were immediate scoffs, jeers and laughter from the crowd and he was crossed off. People who were not present were represented by their accompagnateurs who were also advocates for people present.

UNICEF visited on Wednesday (a day earlier than we originally anticipated) and all went well. The two representatives were obviously very impressed by VHW. One commented that it was a ‘state of the art’ facility for Burundi. Their main message was that Plumpy Nut stock (the third stage nutritional supplement used for malnutrition) will be decreased for a variety of reasons (financial cutbacks a biggie) and should only be supplied to severely malnourished children who are in-patients.

UNICEF is shifting their focus more and more into a community based model with health promotion, food security and cooking classes to deal with the moderate cases. This will mean a huge change for us here, as we supply many with Plumpy Nut.

The challenges and hardships abound on a daily basis here in Burundi and I continue to be amazed by the good cheer, resilience and patience of these people. Their chosen names manifest their wonderful spirit….’Goodness’, ‘Nice’, ‘Good Luck’, ‘Happiness’, ‘Sincerite’, ‘Bonne Annee’ ‘Happy New Year’ (born on Jan 1st!) and ‘I Love’ are some of the people I have been fortunate to meet here.

Helen

Helen showing patients her xiphoid process

Melino showing patients his xiphoid process

Adult male with uvulaectomy
and epiglottisectomy

Three week old baby post uvulectomy

Foot tumor with infection
post traditional healer visit

Girl with endocarditis

HWW and Melino

Patient audience

gRooster gift for Melino

Bea having Plumpy Nut for the first time

Young mother

Women waiting for consultations

2010-02-27T13:49:00.000-08:00

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

2010-02-21T12:31:00.000-08:00

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

2010-02-15T11:26:00.000-08:00

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

2010-02-07T16:27:00.000-08:00

‘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

2010-01-31T14:36:00.000-08:00

A Weekend Breather. . .

It’s a rainy Sunday here in Kigutu…sort of a cosy catch up day, even though it’s warm. Another extremely busy week has passed. Two of the nurses were laid low by malaria and another had an eye infection so Brad, Connie and I were working very long hours in the wards. When we are in the midst of morning rounds, the “gates” are opened for the outpatients and it is a bit overwhelming to see the throngs arrive. It seems at least once a day we get a stretcher case that has been carried in and we go into “emergency room” mode. The beds are always full and overflowing. Malaria has been rampant these days (yes, I am taking doxy). Luckily quinine is a pretty quick cure and people are on the mend fairly fast. Before we know it the sun is setting and we have been running all day.

On Friday afternoon Connie and I took a brief interlude up at the water tower to watch the sunset, very revitalizing to step out even for fifteen minutes.
We continue to have a quite a steady stream of patients who see local traditional healers and come here afterwards with infections or bad reactions. A few examples include: a 22 year old male with a significantly botched and infected circumcision; a 5 year old boy who had severe reactions to a potion and several with infections post uvulaectomies. A mother of a malnourished baby told us that the traditional healer said that her child had a “bone disease” and recommended that the baby’s xiphoid process (the lowest portion of the sternum) needed cutting. We all attempted to explain that this bony prominence is normal. Melino is especially passionate about educating the people to avoid the healers. He has seen too many deaths as a result of their work.

Brad and I gave another prenatal class on Wednesday. All women were tested for HIV and all were negative. Nice.

The solar cooker has been officially inaugurated by Connie who baked delicious banana bread. A much appreciated treat for everyone.

It’s great having a bit of a breather today gearing up for another full week ahead.

Helen

Helen and sunset

Melino showing his xiphoid process

Peanut Gallery watching drummers

VHW women

Prenatal class

Mother and babe recovering from traditional healer visit

Aubery

Fabrice

Connie and sunset

Children with malaria

Celestin upon admission to VHW

Celestin after 2 months at VHW

Bazile's breakfast

2010-01-24T14:04:00.000-08:00

The Power of Community. . .

Community development requires attention and intention and living in Kigutu is no exception. There are several overlapping ‘sub-communities’ here, including: the community of we ‘muzungus’; the community of our residence comprised of muzungus and the Burundian staff; the complete VHW staff (approximately 60 people); the community of the patients and their families; the community of Kigutu and the community of our whole catchment area which is represented by about 50 community health workers or accompagnateurs. None are mutually exclusive, there is much overlap and observing and participating in the dynamics is interesting to say the least.

It’s been another power packed week full of activity. It has been wonderful working with Brad, Connie and the staff nurses making changes/improvements in the delivery of care which will ultimately benefit the welfare of the patients. We have had meetings with the nurses so we are all ‘on the same page’. We are always making efforts to be sensitive and ensure that we are not, as outsiders, ‘taking over’. The nurses are very grateful that we are here to help as presently there is an acute staffing shortage. Connie has primarily worked in the malnutrition ward while Brad and I have worked together in the hospital ward.

Yesterday the three of us tackled the monumental task of sorting and organizing heaps of medical supplies which had been stashed away in a storeroom for too long. All three of us share the delights of a fairly obsessive organizational behavior, so we were in hog heaven. It is still a work in progress, but we managed to get so much accomplished, which was very satisfying. Brad cranked up the music on his computer and we had patients come and watch the muzungus get into it. It was very fun.

Earlier in the day we participated in the community effort to help fix the road to the clinic which has suffered with the recent heavy rains. We dug drainage and diversion ditches which will hopefully alleviate some of the erosion. It was good to be involved. On Friday the accompagnateurs gathered in the new training center and we did a presentation and training on malaria. Afterwards we distributed the donated LED crank flashlights (thank you, Bob Crane), rain ponchos (Bunnings in Cairns), and tote bags which I had procured while in Australia. They also received new photo ID cards and the original photo.

Everyone was excited and pleased to be recognized for their invaluable contributions to the community-at-large. Earlier in the week, five children in the malnutrition ward were transferred to Bururi Hospital for much needed blood transfusions. It was great news to hear that this had been accomplished. Today they will return and everyone is eager to receive them back into the fold. Connie has gone in the ambulance with Elvis, our Translator Extraordinaire, to get them.

Last evening, Will Marsh from Santa Barbara, California, arrived as a volunteer agronomist. (Yes, the inevitable one degree of separation was almost immediately discovered… he knows Grace Bueti!) We are all thrilled with his presence as his expertise will help keep the exceptional food programme on track. We also got the solar cooker Hotpot activated this morning and we are eagerly looking forward to evaluating how it performs here.

Bazile received an early AM phone call on Saturday from his family in Haiti reporting that they were OK. This was the first direct communication he’d had with them since the earthquake. It’s definitely a heart wrench for him to be away from Haiti at this time.

We have had the ongoing steady stream of patients at the clinic, some presenting with interesting pathologies (see the photo of the round worm and also the foot tumours). Each week the amount of patients increase and the distance they travel to come to Village Health Works gets longer. The word is spreading. There is never a dull moment and it’s great to be working hard with such a terrific group of people… lots of love and laughter.

Helen

Melino and Bazile

Insect

Antoine CHW

Alex turns 22 in Kigutu

Trixie hats on Judith and Solange

Helen and Elvis with VHW accomapgnateurs

Helen and Elvis teaching

Connie and Junior Bazile

Will Marsh in the garden

Helen and Will with Solar cooker

After Brad's dance party

Road crew heading off

Road crew finished

Brad and Connie in the middle of the box heap

Foot Tumours

Helen doing dressing on foot

Vomited roundworm sample

Helen, Connie and Brad

2010-01-17T12:44:00.000-08:00

“Home” again. . .

A week since my last entry and so much has happened. The globetrotting, jetlag blur already seems long gone…so out of whack with the time, that I am almost “on track”. Yungaburra to Cairns to Sydney to LAX to JFK (the 24 hours layover at the Fingleton’s was wonderful) to Brussels (where Connie and I rendezvoused) to Bujumbura and finally to Kigutu … definitely a long haul.

The trip was book-ended by two interesting events. Driving down the Gillies Range at 3 AM from Yungaburra to Cairns a large tree had just fallen across the road which we were able to drive around….we were lucky we didn’t come around the bend a few minutes sooner. Driving out of Bujumbura to Kigutu we were caught in a blockade involving people who were disputing land issues. Police were present and a feeling of growing hostility and potential conflict was brewing. There were actually shots fired into the air at one point. We managed to retreat and take an alternative inland route (as opposed to along the lake front) into the verdant highlands past the tea plantations. This was lovely and chilly, but took 6 hours as opposed to the usual two from Bujumbura.

The reunions and welcoming from the staff in Buj and Kigutu were very heartwarming. Cory Fisher, a newly hired project coordinator, and Brad Snyder RN are new expat additions since my last trip and I am excited to be working with them. I feel like I have returned to another home and, once again, I have the affirmation that this community is very special. It’s terrific to introduce Connie to everyone and show her around. It’s clear that she will fit in immediately and we have hit the ground running. Our first night here we had a “show and tell” for the staff with all the contents of our duffel bags for VHW….another Christmas. All the staff loved the photos which I had brought for each of them.

Junior Bazile MD, the Clinical Director, is also new since my last trip. He is from Haiti has just gotten a second confirmation today that his family in Port-au-Prince are alive. We will celebrate tonight. He has hardly slept since our arrival, understandably consumed with worry and fear. All of us were sharing this with him and now we are all heaving a collective sigh of relief, yet also feel terrible about the horrific situation in Haiti.

There have been plenty of nursing tasks for us to tackle. The staffing is short and the patient load and acuity is high. Malaria, TB, malnutrition, severe wounds, pneumonia, lung cancer, diabetes are just some of the challenges. Today we had a woman waiting patiently for a few minutes (she had walked here on her own) while we were busy. We then realized she was a full term pregnancy and brought her right in to be examined. She delivered a healthy baby boy on the spot with not even a peep. The people here are so incredibly stoic and contain their emotions remarkably.

Our laboratory technician, Euphraim was absent the day we arrived. His wife had delivered their second child in Rumonge Hospital and we got word the next day that the baby had died. Cory asked me to represent the “muzungu” staff at the funeral which I did in Rumonge on Friday afternoon. Once again I was impressed by how much the Burundians contain their emotions. Very interesting to compare cultural rituals too.

Yesterday a few of us went for a “Mountains Beyond Mountains” walk and I delivered photos to families whom I had photographed on the first trip. It was really fun to witness their delight at seeing their images and also their disbelief that I actually followed through with my promise to return someday with their photo. How lucky I am to have the opportunity to do this! One man was so appreciative he offered to donate a goat to Village Health Works.

As I write this, the afternoon sun is blazing through the windows and I am looking out at Lake Tanganyika. Soon the fishermen will be out and there will be a myriad of lanterns glimmering in the night. It’s great to be back!

Helen

View from Kigutu

Helen on 'MBM' walk

Kids along the walk

Helen & Connie on walk

Women and children resting on roadside

Girl tending smokey fire inside

Helen with healthy, happy baby

Pierre & Honore heading uphill
with little guys

Woman with umbrella

Helen with newborn wrapped
in one of Trixie's blankets

2010-01-09T03:33:00.000-08:00

January 10, 2010 (egads!)

“Tozosubira”…Yungaburra

“Tozosubira” is a Kirundi word roughly translated “until next time”. . .

It has been a full ten weeks here on home base in Yungaburra. I have been lucky to be able to have this opportunity to recharge and get revitalized before I head off for my second trip (almost 4 months this time) to work at Village Health Works in Kigutu, Burundi. I have had a chance to catch up with family and friends which has been wonderful. It seems as though we get emails every day now from friends, family and acquaintances reporting illness, injury and unfathomable tragedies which makes us count our lucky stars all the more. I am most grateful for my daily swims across Lake Eacham which sustain and nourish my body, mind and spirit.

Helen in Lake Eacham

Since I have been here I have been fortunate to be “far from the maddening crowd”. Yesterday I had to venture to Cairns and into the jaws of the big shopping center for some last minute errands. Oiyveh, what a culture shock…so much obesity and consumer excess, Robert aptly described the scene as “visually toxic”. It is certainly an incredible juxtaposition to life in Kigutu.

During this time I have been able to procure generous donations for Village Health Works. A solar HotPot from Solar Household Energy Inc. www.she-inc.org will help get the concept of solar cooking launched. The community health workers will now be outfitted and equipped with 50 rain ponchos from Bunnings Hardware and 50 mini dynamo hand crank flashlights from C.Crane Company www.ccrane.com. They will also have tote bags from Envirosax www.envirosax.com.au. Diabetic monitoring will now be a reality with 2500 glucostix from NSW Diabetic Association www.diabetesnsw.com.au. Financial contributions have helped purchase three Point One water filter systems to handle 540 gallons per day www.pointonefilter.com. Children and babies in the malnutrition ward will have a new supply of clothes, hats and blankets to help combat hypothermia. Thank you, thank you everyone! My bags are full to the brim!

I’m very excited to be returning to Kigutu where I look forward to reunions with the wonderful staff. This trip will be especially wonderful as I am going to be accompanied by my friend Connie Ghiglieri RN, www.conniegig.blogspot.com, who will be in Kigutu for a month. She lived here in Yungaburra in the 90’s and we haven’t seen each other in 13 years. We’ll rendezvous en route in Brussels and will hit the ground running in Kigutu with all the work that needs to be done.

To keep my luggage weight below the limit I will dress in multi-layers! It should be interesting given all the increased security. The extended forecasts for the airports I will be traveling through reveal clear skies. Given all the potential snafus with travel these days I can only “prepare for the worst and hope for the best”.

There is no word in Kirundi for “goodbye”. I like this, as goodbyes are always very hard for me. I’m not quite sure when I will be returning to Far North Queensland, probably in October 2010. So, it is “Tozosubira” Yungaburra. . .

Helen

2009-11-08T12:48:00.000-08:00

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

Helen back on the verandah in Australia

Feeding marasmus baby

Felicia with baby born in hallway

Kwashiorkor baby

Kigutu kids collecting firewood

Kigutu kids playing in mud

Clearing roadside with community crew

HWW with army personnel

Dramatic weather and verdant hills

Mandela and Melino

Kigutu drummers

Alex and Dziwe cranking out in cyberspace

Helen at Buj Airport

Amazing sunset from Kigutu

2009-11-02T10:40:00.000-08:00

Fingers Crossed. . .

Robert here, this came in last night:
"Heading to the airport shortly. Fingers crossed no glitches. . ."

After a 24 hour flight delay (due to a bird apparently being sucked into one of the plane's engines in Brussels. . .) Helen's departure from Burundi appears to be back on track. At last report she was scheduled to depart Bujumbura at 9:00 PM Monday.

She hopes to be in NYC Tuesday afternoon by way of Nairobi and Brussels. After a night in New York, where she'll be giving talk to the TB Alliance on Wednesday, Helen then heads straight to the airport to fly to LAX (where she'll meet up with our friend Becky who is coming to Australia for the first time) and then on to Sydney and finally touch down in Cairns Friday afternoon, where I'll scoop her up and bring her up the Gillies and finally have her home here on the Tablelands for a little while.

I figure she'll either jump straight into the lake or drop into bed. . . We'll keep you posted.

Cheers, Robert

Updated 3:30PM, Tues. Nov. 3, EST:
Just got a call from Helen who was in New York City, looking forward to a hot shower. . . She'll be writing a posting and sending some photos for the blog soon.

2009-10-25T14:20:00.000-07:00

Home visit. . .

I have been reading Nicholas Kristof and Sheryl Wudunn’s recently published “Half the Sky” about the tragic plight of women throughout many countries in the world and some of their stories of overcoming oppression. It makes me think of so many of the amazing women I have met on my travels in Kashmir, East Timor, Tuvalu, Sierra Leone and now Burundi. (I also think of the men with whom I have worked who work hard for women’s rights too). I am only 21% of the way through the book (the Kindle notes the percentage read at the bottom of the “page”) and I am devouring it. Despite the tragic tales, it is very inspiring.

I was thrilled that they cited my friend Dara Cohen’s research. She and I met in Dili, East Timor in February 2008 and met again in the Dili airport as we were both departing on the day of the double assassination attempts on the President and Prime Minister. Dara is the person who told me about the West Africa Fistula Foundation too…the dots start connecting.

Today I accompanied Melino on a home visit to his mother (with multiple medical issues) at his childhood home farm. We were also delivering two elderly patients home. We drove down the rough road from Kigutu to the paved road, drove south on the paved road for about 15 minutes and then took another road back up into the mountains to Vyanda (the town I walked to three weeks ago with Tolstoy). As soon as we pulled into Vyanda’s town center, which had throngs of people out for the local markets and church services, the vehicle was mobbed with well wishers. Melino is obviously a well loved and respected member of this community.

The air was cool and the hills/mountains had a verdant hue. The eucalyptus trees were plentiful. I had to blink to realize I was in Burundi and not on the Tablelands of Far North Queensland.

Melino’s Mum, Candide, is a very hard working farm woman in her mid 70’s. She has had nine children and was widowed in 1994. Despite not reading or writing well herself, she has ensured that all her children have been educated. All are successful in their fields… a doctor, a professor, a civil engineer, business owners, all of them major contributors to Burundi’s positive future.

It is frustrating not to be able to speak Kirundi with her, as I know that her life must have incredible depth and that she has many stories. For example, Melino told me a little about her hiding from the rebels in the war. Meeting her was inspiring and humbling; her “simple” life as a mother in the mountains of Burundi has made a huge difference to this struggling country and its people. It was an honor to meet such an amazing woman.

Tomorrow we will begin a three day vaccination programme for under five year olds. I imagine that we will have a tsunami of patients.

Helen

Barack Obama Shop

Cow paddock fence with bananas at Melino's home

Helen with cow

Melino and Mum

Melino with calf

On the road blood pressure check

Woman with bar of soap on her head