Friday, December 16, 2005

Pictures to go with the last post

Pictures as promised (corresponding with the text of the last posting...)

Nicole (our head nurse) with our new white board!

The long awaited, much needed mosquito nets! (donated by Refugees International)

Ben, my medical coordinator supervising the distribution of the nets

Christian, one of my refugee nurses explaining the importance of tucking the nets under the sleeping surfaces to keep the mosquitoes out...

A mother and child watching their new bednet being installed.

Shelter to shelter installation was time and labor intensive, but a great way to educate the population and ensure the nets are being used properly... our nurses teamed with the animateurs (community health workers) going to each shelter and installing the nets. Unfortunately often there are two or three beds (dry grass on a plank of branches) per shelter and we could only provide one per house - (the children and pregnant women are the priority to sleep unde the nets). We should be able to provide an additional 1200 nets (another one for each shelter) mid January - thanks again Refugees International!!

The ever present crowd of children - the little boy on the right probably had a greenstick fracture of his distal humerus - I had put the splint on him the day before this picture was taken and I caught him running (and falling) again the very next day!

With the rainy season ongoing, even on this rocky hillside (with a lot of work and care) there are little gardens cropping up throughout the camp. This boy was extremely proud of of the result of this hard work with his sunflower towering over his shelter...

Little boys will like trucks everywhere in the world - and the children here are quite adept at making replicas of our trucks from plastic bottles and bits of wood and string.

Wednesday, December 14, 2005

One week remaining...

I’m not sure I can describe all these contradicting emotions that continue to course through me. It’s hard to believe that it’s already the middle of December and I have essentially completed my time here. I am so so proud of my staff at the health center – I was in Kigali most of last week for meetings with UNHCR and other organizations and coming back the health center is running without a glitch– everything is in order, in fact improvements have been made, there are new educational posters up that they have requested from the local hospital and the medicines are newly organized and labeled in our emergency drug cabinet. The folders continue to be in order with the admission files, the community health workers and guards continue to efficiently triage the patients registering their names in the medical record books and taking their temperatures and weights, my nurses continue to give educational lectures each morning… and we finally have a white dry-erase board (after ordering one in July!) to track patients and schedules… I amuse my staff to no end with how excited I get over each new item – I was bouncing off the walls after the white board came in – and did cartwheels when we got our mosquito nets!! (literally)

I could just be feeling slightly sentimental (or more than slightly) but I was sitting in morning report yesterday… remembering my first few days when I started out back in July without anything!! No schedule, (start and finish times stretched well into the late mornings and evenings - I was even chided last week by Alphonse for being 5 minutes late one morning! He is one of my refugee staff - and previously one of the worse offenders holding to the "African Standard Time" method of punctuality - meaning up to 1-2 hours late is on time )- no system of hospital rounds, no triaging, weighing and taking temperatures and doing consultations ourselves, no cabinets for medications, no laboratory, no bed numbers, no admission notes, no medication records no OB department, no HIV testing no Family Planning materials… working straight through lunch into the evening, no one washing their hands, no one even examining patients most of the time, every patient being treated with 3 or 4 antibiotics unnecessarily… we have come such a long way. And I really feel like it’s true not just something I’m saying to convince myself – that my job is complete here… that while there never is an end to learning – these amazing nurses, Congolese refugee and Rwandese national alike have absorbed every detail of every aspect of medicine I have been able to convey – from administrative to fundraising, to medical record keeping to patient care… and have really taken an ownership and pride in their health center and hospital… our health center and hospital. It’s such and overwhelmingly joyous feeling I could explode at times…

And so I float around this last week trying to soak it all in – remembering where we started and the miles and miles we’ve traveled together in 5 short months. I am so grateful to Barry Wheeler, the amazing country director for ARC for Rwanda and to Larry Ronan and the rest of the Durant crew back in Boston for giving me this opportunity – it was such a perfect almost eerily too perfect combination of events – this new camp without a doctor – my being allowed to build something – to create a health center and hospital from the ground up, the uniquely talented and hardworking local staff and refugee staff alike with everyone working so well together as a team … the support from Barry who pretty much just let me run with anything I wanted to do… any idea I had was met with complete acceptance – “go for it” was the most common phrase I heard. And the blessings that came seemingly out of nowhere whenever I wanted to give up - whether from the MGH Chelsea Urgent Care crew at home, my family, UNICEF, Refugees International, EGPAF... I have been incredibly lucky.

I am almost certain I will return in April – depending on my funding – to help finish the last piece – the HIV program. Our PEPFAR funding was approved and I just found out we have received additional funding from OPEC nations through UNHCR (part of all those agonizing meetings last week) also for HIV activities – So my job largely in April (if I’m able to return) will be setting up a HIV testing and treatment center within the camp. We have been so fortunate to partner with EGPAF and the local hospital but only having testing available once a week and having to transport patients to get started on HIV treatment is problematic. I’m thankful we have the funds to start our own programs in the camp next year.

More thanks are due. After feeling completely and totally sorry for myself over Thanksgiving but then getting all those supplies from UNICEF – I received more care packages from home.. thanks again to Tim & Leigh Anne, mom and dad (as always), Tom & Kate Faber, and Johanna Cooper, First Presbyterian Church of Vancouver, Washington… Also Eileen and the rest of the Refugees International crew came through in a big way (see getting us the donation that allow us to purchase mosquito nets – for each household in the camp – actually there’s enough money for two for each household. Malaria continues so fiercely here – people are suffering so much and while we have become quite adept at treating it – it’s nice to have a little going for us on the prevention side.

So it’s with such pride and sorrow.. so bittersweet I can hardly breathe as the camp kids rush to me every morning, that I am preparing to leave. What I will miss the most is those smiles and voices greeting me every day. What I will not miss – at least not for a while is the feeling of desperation – every day being up against a wall – without a safety net – no panel of experts to rely on – and death being so much more a reality – especially children dying. Needlessly – really all such easy “saves” in the US, but we have done pretty well, no one has died of malaria (yet) – and no one really should die of malaria anywhere in the world - but I know the local hospital in the village has up to 5 deaths a day, most days, from malaria. It’s a testament to the hard work of my staff in education so people present early with symptoms and their skill at treating malaria that have allowed us to escape thus far without a death. I have become even more convinced that education is the essential building block of health (of course along with clean water, adequate nutrition, medicines…)

Pictures to come of our shelter to shelter installation of mosquito nets, and of course more of the children. I will be home so soon it’s hard to even imagine the reverse culture shock. I look forward to catching up with everyone when I drop out of the sky… More to come soon (yes, pictures I promise) …

All my best,