Catch-up

Here is a photo catch-up to attempt to make up for some very bad blogging over the past few months.

1) Trip to Tanzania.  I led a training of trainers in Arusha, Tanzania on Pima Point-of-Care systems.  In February. Yes, that is a long time ago.
They are using a slightly modified version of the systems training package that we developed in Uganda, and it was fun to see how the model would work in a different context.  I didn't get to climb Mt. Kilimanjaro or Mt. Meru, but I did get to see them!  Maybe one of these days.

2. GHC 3rd quarter retreat.  The fellowship year is winding down!  We had our 3rd quarter retreat at Lake Nabugabo outside of Masaka.  Our end-of-year retreat is at the end of July -- I can't wait to see all the fellows from Rwanda, Burundi, Malawi, and most especially the US (all the Africa fellows got to see each other in January).  I'm also excited to welcome the new CHAI Uganda GHC fellows - I think they are going to be great.

3. Kampala history tour -- Julie, one of my good friends here, organized a Kampala history tour for about 15 of us in April.  It was a lot of fun to be tourists in the city we live in and do the things we never otherwise get around to.  We visited the Gaddafi Mosque, Idi Amin's torture chambers, and the tombs of the kings of the Buganda kingdom.  We had a hilarious conversation with our guide about how they are destroying all the tombs (to be fair, most of them have already been destroyed and rebuilt) and rebuilding them with more authentic materials so that the UNESCO board will approve them as a heritage site.

4. Pima rollout -- the rollout of 250 machines is well underway.  There have been major and minor hiccups, but the fact that things are actually moving is really exciting.  I've been helping out with some trainings and with organizing the trainers, and it has been awesome to see facilities ready to put our systems in place and really doing a good job integrating the machine.  It is also tough to see facilities with far too few staff to implement the systems or with major issues (like no power within an hour radius) that will prevent them from using the machine well.  We have an intern coming on Sunday to work with me on reviewing the rollout, and I'm excited to get some preliminary data on what is going well and poorly in the rollout.

My co-trainer Stephen was an excellent model (and an excellent trainer), though he was kind of confused by my request to take a picture of him.

 Frank (second from right) is one of the best trainers I have worked with.  I love it when I get to work with trainers who really care about their work and really understand the key messages of the training package - their experience as lab technicians and health workers helps me better understand what the key issues really are.

5. The future.  It is looking like I will almost certainly be staying in Africa with CHAI beyond August in some form or another.  Some details need working out, but I'm excited to keep doing work I enjoy and care about, and to keep living in such an interesting place.  At the moment, I'm even more excited to come back to the US for a little while in August and see many beloved people.

This photo is meant to symbolize me looking towards the future....

Lake Mburo weekend

I spent the weekend in Lake Mburo with Ally, Ashley, and Noorin.  It was beautiful!  We went on a mini horseback safari, went for a sunset boat ride, and hung out at the spectacular fancy hotel that we did not stay at.   

I just really love zebras...

Ugly warthog pretty sunset

 Lighting got messed up, but those are zebras behind me!

 Where I will stay the next time I have visitors....

Burundi

I spent four most excellent days in Burundi this past week visiting other Global Health Corps fellows' placement sites and enjoying taking in a new country.  It was fun to practice French a bit too!
I arrived Thursday morning, and spent Thursday night and most of the day Friday at Village Health Works in Kigutu, Burundi.  VHW operates under a similar model to Partners in Health (providing free, high-quality healthcare to rural communities while engaging with other social determinants of health) and its founder was the topic of Tracy Kidder's haunting book Strength in What Remains.  It was fascinating to visit the site and see their successes and challenges.

VHW has a Pima machine that was purchased by CHAI two years ago for a pilot run before CHAI left Burundi.  However, due to government bureaucracy and challenges with suppliers they haven't been able to procure reagents for it for a full year even though they have money to do so, so the machine has been sitting idle and patients have not been able to receive CD4 results and begin antiretroviral therapy.  I wished I could have smuggled some Pima supplies out of Uganda!  From what I could tell, they provide excellent antenatal care and PMTCT services, yet they still don't have the ability to perform cesarean sections, so they have to refer patients needing them to a nearby hospital that is frankly awful.

Being there reminded me of the difficulty with focusing purely on health delivery.  One of VHW's big activities is educating people in their catchment area about nutrition.  Cassava, a nutrient-poor food containing cyanide, is the staple food in their region; its consumption exacerbates malnutrition.  One of the doctors at VHW told me that in the less-fertile areas of Burundi where cassava doesn't grow, there is less malnutrition because people are forced to raise healthier foods!  It has been a major struggle to change behavior to encourage farmers to grow foods that might not taste as good but are much healthier, and this has caused significant loss of life and productivity.

It also reminded me how interconnected health systems are.  Despite being well-run and fairly well-funded, VHW often struggles to get the right supplies and to provide all the services patients need because it is still in many ways reliant on the very weak Burundian health system and health supply chain. I think VHW's work is important not only because it allows people who wouldn't otherwise be able to access quality healthcare, but also because it provides a model of service delivery and should be able to become a teaching hospital for Burundian doctors down the line.  At the same time, being there reinforced my belief in the need to work with and strengthen government health systems, as these impact patients throughout the country and can affect even a relatively independent organization like VHW.  Tough to do in the most corrupt country in East Africa though.

Over the weekend, I met up with fellows based in Burundi and Rwanda who were in town, and had a great time hiking in the mountains about an hour from the city, going to the beach (pretty despite bad weather - Bujumbura is right on Lake Tanganyika), and eating the best Italian food I have had in Africa.

 With Claire, the current GHC fellow at Village Health Works, and Melino, the Medical Director

 Part of the VHW demonstration farm

 Claire working with Peter at VHW

 The lab at VHW

 Hiking near Ijenda

During a mini adventure when our driver, Justin, lost his keys during our hike.  We had to wait more than an hour for his buddy to bring a back-up set.  He decided we should go for a walk to town to kill time, and we ended up accompanied by these ladies with seriously excellent baskets.

 At Bora Bora beach club with Cori and Leah, two of the fellows based in Burundi

 By the market in Bujumbura with Cori and Leah

Terrible photo of a pretty great dance party at Village Health Works