Thursday, August 04, 2005

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


At 6:28 AM, Anonymous Mom said...

You are doing a lot in such a short time already. With everything is so limited, you can only do what you have in hand. Be patient, you can not solve the entire refugee health problem in few days. You are a good teacher, and you put what you know to work. I am sure the help from the free and rich countries and the generous rich people will come. We pray for God's blessing.

At 1:24 AM, Anonymous Anonymous said...

ann, we're working on getting you any needed supplies from those we no longer use - also funds - where would we send it and to whom? - everyone at urgent care sends their love --kathy

At 1:36 AM, Anonymous Anonymous said...

Hi Ann, It is quiet here in CHUC tonight,it's the Latino festival.I'm sure we will see a few later on. Ilook forward to reading your journal entries,and can't imagine.You're doing great things.We all hope to help you somehow.Your in our thoughts and prayers. Paula

At 1:48 AM, Anonymous Anonymous said...

Hi Ann
I love visiting your blog site, my first ever to be honest.Your work sounds incredible, and I can't tell you interesting I find hearing of it. Thank you for for all you are doing. We really miss you here but feel very connected. Take care, and know that you are in all our thoughts. Valerie

At 1:58 AM, Anonymous Anonymous said...

The Martin Luther King Jr Foundation in Atlanta has money for projects, as well as the Carter Center. I will write back with more info

Leigh Anne

At 2:23 AM, Anonymous Anonymous said...

Hi Ann,

A pathetic novice in the realm of fund raising, but I found a few links that may be of some help... (The Carter Center) ( Rollins School of Public Health )Emory University (Institute for African Studies at Emory Univ.)
Edna Bay is the director, and the above is her email.

If you are able to accomodate students and have them do some type of internship at the camp, the school may be interested in donating. It is a long shot, but nevertheless, Emory is dripping with funds, and very interested in African affairs. Well, taking on students is a big task, and you have enough to do, but if you were able to vaccinate 500 children in under one month of arriving, then you may be able to sway Emory into giving your camp some funds.

The Woodruff foundation is another thought.

At 1:33 AM, Anonymous Anonymous said...

My dearest Ann,
You are changing so many people's lives each & every day. It's amazing work! And I'm sure that just as much as you're changing their lives, you're changing as well. We all miss you dearly back here in Boston. Keep safe & look forward to hearing more about your experiences! - Ramon

At 8:23 AM, Anonymous Byron said...

Ann, I have heard from many insiders about the limitless bureaucracy of UN impeding supplies, etc.. I'm just glad I don't have the higher-up job allocating precious few resources. Reform? I don't claim to have any answers, that's what you MPH people are for.. :)

Nalidixic acid anyone? Chloramphenicol? We used these in Mali.. along with worm meds and malaria stuff, for anyone with fever. I imagine you are doing similar in following local practices. Sorry to hear about your daily frustrations. Let the emotions, even the outbursts, make you stronger -- temper them, maybe, but don't feel bad about them or deny them. Your heart is what makes you so special, Ann. Never apologize for compassion.

I wish I could visit you there..


At 1:51 AM, Anonymous Anonymous said...

Hi Ann,
One person can't solve all the world's problems let alone overnight. But with caring and dedicated people like you, progress is being made even at painful pace and small steps.

As Chinese proverb says: “A journey of a thousand miles begins with one step.”

You have been to many places in the world before and as you know most of the world doesn’t operate in the high efficiency we’re used to here in the US.

Don't let the frustrations of get you down. Be tolerant and patient and you will inspire the coworkers around you.


At 7:55 PM, Anonymous David T said...

Hi Ann! What a wonderful blog you have. I'm especially moved by all those amazing pictures. By the way, you wouldn't happen to have teleconferencing capability there, to set up a chat with the med-peds folks back home, would you? (Yes, we can always dream...) Be encouraged, and stay well! Blessings, David

At 7:55 AM, Anonymous Nan Weston said...

Hi Ann,

Your parents sent me a note about your activities with your "blog" address, and I've sent it along to Lesley and Rob. I wasn't sure just what a blog is but am finding out. You're a grand gal, Ann, and it humbles me to read of your activities. I'm sure you don't see the nobility of what you're doing in the day to day frustrations, but I do. Know you are upheld in my prayers.
We're on the road at the moment between FL and WA so I don't have computer access all the time, but I'll be checking in frequently to your blog. God Bless....

At 6:10 PM, Blogger shanliu said...

Well..give me a year and I'll see what i can do about Paul Hewson's number :))))
(less than 2 months till october 3rd - i'll cheer my heart out for ya!)
Hang in there! It is such exciting
work and the Lord is mightily using
your intelligence, compassion, diligence and love for people in real ways.
Take care! shan

At 6:52 AM, Anonymous Anonymous said...


hello from Korea. Just yesterday, I was complaining to my fellow Army officers about the living conditions (mosquito and rat infested tents)... complete with communal showers, humid monsoon soaked days, with the smell of human excretement as fertilizer for rice paddies. But... at least I have internet... After reading your entire blog, I realize that I have nothing to complain about.

Take care and let me know if you need anything. I will be here in Korea until 8 Sep 05 and then I am going to Hawaii from 12-22 Sep 05 to visit Tim, Leigh Anne and Emily.


"Blessed are the peacemakers: for they shall be called the children of God."

-- Matthew 5:9

P.S. You should probably post your mailing address (again?) so that everyone can send you stuff.

At 2:15 PM, Anonymous Anonymous said...

Hi Ann, Love hearing from you. You are an amazing person for what you are doing? I know you could use alot of money but what can we send you in a care box? Chelsea is not the same with out you. Stay safe and look forward to having you back. Mary P.
P.S. Where do you want packages sent?

At 8:48 PM, Anonymous Anonymous said...

Hi Ann, Read your blog. Amazing work that you are doing. You have an inspiring energy and so much to give! Please post your mailing address again. Things at CHUC are much the same but we really miss you. Be safe in your journeys and I'll keep you in my prayers. Terry


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