A Vaccination Campaign and Kigali for a day

Wednesday morning (Aug 3rd) rolls around and I am still nervous about the vaccinations that are supposed to happen today. We get to camp early 7:30 AM to round on our patients before meeting up with the local district health coordinator who is bringing supplies and nurses to start vaccinating at 9:00.

All of our patients are recovering, asthmatics (who I'm treating with aminophylline drips - we have no albuterol!), malaria, a child with a septic hip, a severely dehydrated 2 kg baby (who I'm sure has HIV but we don't have the money or the laboratory for testing --> I'm working on it though..) who is doing better. The nurses are now asking questions left and right and rounds is quickly becoming my favorite part of the day. We talk about logical antibiotic choices today and stepping back and assessing the clinical condition of the patient before shotgunning with 8 million different antibiotics. Even in the past week I can see a difference in practice patterns, the new admits don't have 4 antibiotics written for.. there are less IV's and more Oral Rehydration Packets being prescribed. It's a slow process but so gratifying.

After finishing rounds we make our way out to the tent where there ostensibly were supposed to be stations set up, corridors roped off and lines and lines of children w/ parents waiting to be vaccinated. It's 8:45 and the district health supervisor and nurses will be coming in 15 minutes. The tent is completely empty. There are no chairs or tables... there are no community health workers... there are no patients to be vaccinated... As hard as I pushed for the vaccinations to happen this quickly - I definitely feel like it's an embarrassment to me and the camp if things don't go well.

I am as frustrated as I have yet been in Africa - and I let it show... which causes consternation of the nurses and a flurry of activity around me (none of which is very productive). I think that while men in this society often are stern and show when they are not happy - the women do not and so everyone is surprised. I manage to take a deep breath and start delegating specific tasks to specific people.. I should have a little more faith because once directed - in a relatively short amount of time we are set up. The vaccines arrive and so do flocks of people and we are underway...







There is very little for me to do once the lines start moving and the nurses do the vaccinations - I sneak away to the nutrition center to check in on the inpatients there and see the large noon-time supplemental feed and 3 of the most angelic little girls, two with the largest smiles I have seen on children since coming here. They must like their porridge. I tasted a bit and can't say I cared for it too much...


The three feeding center muses

I feel badly that I almost lost my temper and as Ben and I debrief later that night he told me he had a meeting with the Community health Workers (CHWs)who are all refugees - they were chosen because they could speak French and read and write a little, not because they have any medical background and they weren't clear as to the urgency and importance of vaccinations. In three weeks since they were appointed they have had no training at all. As with most things here it is not deliberate laziness or insubordination, it's just lack of instruction. We draw up a lecture schedule of basic health topics (hygiene, prevention of spread of infection, malaria etc) and I ask Ben to bring this back to the C.H.W.s and ask for anything else they would like to learn about. They are delighted - and also want to help with the weighing of patients and taking vital signs!! Which I'm glad of because we did not have any money in our budget to hire any new workers... Around 500 children were vaccinated Wednesday and about that many tomorrow (1200 kids < 5 yo here) and they received *all* vaccinations which I am very impressed by: BCG, Polio, Diphtheria, Pertussis, Tetanus, H. flu, Hep B and Measles!

Thursday (Aug 4th) and I am back in Kigali after seeing the 2nd day of vaccinations start *incredibly* smoothly - everything is completely set up by the time I get to camp at 8:00 AM! (Oh ye of little faith!!) I meet with Barry (the country director) and two U.S. State Department /BPRM (Bureau of Population, Refugee and Migration)folk who are helping us with a proposal for funding to start-up HIV education / treatment in our camps. There is a lot of paperwork and numbers involved (two things I'm not fond of) but it is so important and even though the amount of money they *think* they can give us is less than 10% of what we need, any bit helps and we'll see where this goes. In the meantime I will dig around for other potential funding sources (Clinton fund, Does anyone have Bono's address or phone number?)

It's hard because refugees fall between the cracks and aren't written into anyone's specific plan when it comes to HIV education and care for Africa. We've spent so much money on just getting clean water, latrines and dwellings built (all of which are *absolute* essentials) that there really is very little left over for anything else. Even the medications are coming from money pulled from other parts of the budget. The UNHCR is supposed to provide satchels of "essential meds" but have not yet sent *ANY* - once again I don't think it's a lack of will - as Barry says if they *had* them they would send them - their budget has been slashed as well. So I'm becoming an expert in creative management of medical problems...

Anyhow I'm in an internet cafe in Kigali tonight after making an excursion to the "Chinese Store" run by a family from Shanghai who came 7 years ago to Rwanda - I didn't have enough time to ask their history as my cab had its meter running outside - but I'm sure it's fascinating, maybe on my next excursion... I even got to speak a little Chinese to the owner which with the recent Spanish to French / bits of Kinyarwandan transistions is really quite comical but she does understand most of what I'm saying. The Chinese Store is famous in Kigali for having everything from volleyballs (yes I bought one) to thermoses to Irons and every kind of paper or dishware product you could ever imagine - and yes.. it's all made in China.

Thank you all for your messages - I have read them all and love reading them (Maggie, Jackie, Paula, Kate, Janet, James, Louise, Nii, Don, Karon, Kate, Shan, Syd, Sharon, Anna, Melissa, Joyce, Tim, Amy, Byron, Tim & Leigh Anne, of course Mom & Dad.. sorry if I left out anyone - it's getting late and the cafe owners are glancing daggers at me...)

Back to Ngarame first thing tomorrow where I will spend the weekend on "call" - I've been warned it's deathly boring *and* still no internet access, but I'll read and catch up on sleep, plan my lectures and hit the volleyball around with the kids... I'm sure it'll be a nice pace compared to the last few days. I will post whenever I get in internet range - thanks for all your well wishes. Lotsa love, Ann