Week 3

Amahoro(hello!) as they say in kirundi

How are you, for example? or Good morning teacher is what the little burundian kids yell when they hear English. thick african accents. It is their only two phrases. Not sure where the "for example" comes from but it is funny.

The chronicity is what gets you. The trickle down, little at a time constant nature of it. The ho-hum tuesday afternoon business as usual nature of it all. it is not a famine. not an international emergency by international standards. its just the constant stream of malnourished children that get admitted over here. with TB, with malaria. with HIV or just malnourished. casava bread that sits like a rock in their tummy. not an ounce of nutrition. the kid below is a before and after 2 months of intensive nutrition. It tells the story better than I can.

we are off the grid here. there is rarely electricity powered from the generator. our xray machine is broken and everyone has a cough. the nearest hospital is on strike. all the government doctors are on strike and the government is threatening to physically force them to work. the docs are asking for a 1000 dollars a month. they are currently paid 100 dollars a month. so it could be a while
we need a technician. there is no technician. we keep joking that in this country we need a book called where there is no lab technician. where there is no architect:)
but what we do have is man power.
people who care. who know their local community. who are barely paid but paid none the less to daily trek up and down hills to deliver medications. community health workers that hand deliver HIV medications and TB medications to patients.
directly observed therapy. 45 community health workers right now. and when they call to say someone looks especially sick in the community- is coughing up blood, is losing a lot of weight, we send our ambulance along the pot holed steep mountains to go pick them up.
it is a good system. community health workers. accompagnateurs in french. accompaniment. an antidote to despair.
went on some home visits this past saturday. walking through the streets and going into houses and sitting on floors and talking to patients. it is the one thing we can offer for all our lack of equipment and tests.
joselyn died yesterday. the only dignity we could provide is changing her soaked soil gown as often as possible and put her in a private room. not really dignity. something resembling dignity. dignity with this degree of poverty. i dont know if its possible. her daughter, irene. 10 years old. she has been on the compound since early February. everyone goofs around with her. if you start an NGO medical hospital, what do you do with the orphans who are not sick but have nowhere to go? what is your commitment to them? do you pay for their school?
there are alot of questions that come up.

heading to Rwanda on Thursday for a week to see the Partners in Health site and learn how you work as an NGO with the public health infrastructure to drastically change health outcomes. They are a success story touted by Bill Gates and Clinton and the rest. it will be interesting to see how you get from here to there.
this Haitian doc, the director of Partners in Health was here last week. he was talking a bit about the start in Haiti. He said when him and Paul Farmer started in Haiti they didn't have a building or a lab or other doctors. but they just started, in the poorest part of the rural Haiti. Because people were dying. and you had to start, he said.

hope you guys are good. let me know if there is anything from East Africa you want me to pick up.