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.

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.

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^th birthday 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.

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

“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

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

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

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