Nearly two months on…

hey guys,

hope this finds you well...

If you are born blind, do you dream in color? And which one among them is red?
Our naming of excellence and our identification of despair. What is the reference point?

Reference points and standards, gold or otherwise.

My reference points are so different than the locals here. What is possible in health care? What constitutes unimaginable suffering?

We went to meet with an NGO working on depression and mental health stigma in Burundi. There is one Burundian psychiatrist in the whole country. The local official told the NGO- I don’t know why you are asking about depression and stress from the war, there is no problem.

He said “there maybe one foolish man in the village but if you send him to big city, then we will all be fine”. When collectively everyone is scarred and scared or has become a refugee in some shape or form, it becomes not worth mentioning almost. Or at least they rarely do.

Two children died this week of malnourishment. Before them, very sick but never dead. Always to the brink and back.
These are the first ones I have seen die.

There is a dirt road after another brown dirt road. Isolation and potholes and puddles and then suddenly a small lone town and in that town, a wooden hut. And in that wooden hut, A Coca Cola. Or a Fanta. Refreshing as usual. Orange or Lime.

Every single country in every remote setting I have worked in, on the bank of Lake Victoria in Tanzania, a refugee camp in South India, Southern Mexico in the mountains, Coca Cola has figured out a way to deliver, with repetition the same product consistently.

And we can’t figure it out. UNICEF and the Clinton Foundation ran out of Plumpy nut.
of course plumpy nut is the end of so much that didn't happen for kids to die of malnutrition.

and two children died this week of malnutrition.
Their skin was peeling off, and they still looked wasted but they were starting to eat and I thought, getting better. And then Tuesday and Wednesday, they died. Back to back.
Reference points…

The Burundian reference point is that this is everyday life. The doctors and nurses and patients realize it is miserable and unjust and they imagine something else but they don’t really have a reference point of a place where nobody dies of hunger, rarely of TB and never of malaria. And if Coca-cola can imagine parading their coke into every crevice on the planet and then do it effectively, there has gotta be the organizational structure, the technology, the infrastructure, the financial push for us to figure it out.

the reverse brain drain will be simple interface technology that is applicable here. Solar energy. Cell phones that record patient data and can be used by community health workers. Electronic web based medical records. Stand alone hand held machines that do all kinds of labs. And cheap enough to not exclude the most destitute. Fingers crossed.