Wednesday, April 30, 2008

Caravan escapes continue...




It has been a wonderful and exhausting week. The volunteers had a wonderful safari on the weekend and re-energized themselves for a busy week to come. The Ngorogoro Crater was in full bloom and awe inspiring. They saw the BIG FIVE (which is what every safari goer wishes to see...Rhino, Leopard, Cape Buffalo, Lion, Hippo). They even saw a black Rhino Mama and Baby!! They enjoyed the Masai Village and spent money on many types of jewelery and other souvenirs. They were in three safari trucks and one group had a terrifying experience on the way home to the hotel in Moshi after leaving Arusha. They were stopped after dark by a Masai with a spear and a stick standing in the center of the highway. There was a group of men in the ditch area and everyone thought it was a carjacking. In turns out that they were stopped to help transport an injured man to hospital. A Masai riding a bike had been hit in a hit and run and left injured in the ditch. Our group (most health professionals!) took him and a friend to the local police station so a report could be made. The police were then to transport the man to the local hospital. Despite all my time spent in Africa, I have to admit, that woul dhave started my heart pounding as well...

We had a stellar day at the women's center on Monday. Immigration came by twice apparently looking for me but both times I was off running an errand! They did not harass us further and we saw about 300 Mamas and babes that day. We acquired another women's center resident, a 19 year old woman who is pregnant. She was employed as a maid in someone's home and was made pregnant by one of her employers. When they discovered she was pregnant they expelled her from the house. She returned home to her grandmother and was told she was not welcome and she should return to those who got her pregnant. She somehow found her way to us and will stay in the shelter until we can find her a more permanent and secure solution.

We spent Tuesday at Kilema Hospital in rural Kilimanjaro region and saw approximately 250 Mamas and babes. The population in th eregion is much poorer than in Moshi, mostly subsistence farmers. KWIECO came and provided legal counseling as well, which they have done at each site. Mama Minde's comment at the end of the day was that most of the women who asked to see her largely have issues of poverty, not necessarily legal. The Kilema experience was very satisfying for everyone. We had some interesting and sad stories presenting to us. It was good to be able to provide them with a free health assessment, education and HIV testing. We had a number of positive tests and much time was spent to counsel them about what the diagnosis means and what they need to do to continue living.

We went to Himo on Wednesday and arrived to a large and quietly assembled crowd of over 300 women and kids. We gave out 200 numbers as we were only 2/3 of our group (with the others doing a second day in Kilema). We told those who did not receive a number that they could come to the women's center for the final day on Thursday. We only have a half day on Thursday and hope to see about 175. We have referred a number of women back to the center in a week to meet with Mama Agnes so that we can learn more about them and sort out what the center will be able to do for them with its various programs that we are developing.

The women are incredible and inspiring (see pictures and you will fall in love). We have posted a number of pictures of them. The kids are beautiful and the mud is disgusting! The rains have hit us hard this week in Himo.

Sunday, April 27, 2008

Canadian Passports are bulletproof...sort of






Well, we had a great day in Himo Town on Thursday with our full group of volunteers minus 2 who were ill. Irene arrived quite sick with a Canadian Flu and has taken a while to bounce back. Despite her best efforts to come to Himo (she is a trooper!), the heat and likely the smell in the building we were working in, sent her back over the edge. I sent her back to Moshi in a taxi to take Jess (Jenn's nanny from Canada and a future public health professional)some cipro (antibiotic) as she was bed ridden with stomach grumblings. Valerie Macloed, one of the family medicine residents who is here with us (who climbed Kili last week and started the caravan the day after coming off the mountain!), was down for the count from the previous day, having been admitted to hospital here with vomitting and dehydration. They gave her some IV fluids and we picked her up that evening. It seemed like a good idea to get her to stay home from Himo...it is a bit hard on anyone's constitution!

The day went well. We saw 315 people. We sent away more than 100 and told them to return next week for our remaining day there.

On Friday we were had almost a full contingent of volunteers and arrived at the women's center for our third caravan day there. There were over 1000 women and children waiting to be seen...I actually felt a sense of panic but after about an hour we had a system wereby, 200 were given numbers and told to stay and another two hundred were given numbers and told to come back on Monday. The remaining people were told to go home and try again on Thursday or to come back to the center when our clinic was up and running three mornings a week. We don't know the exact date we will open but we hope that it will be within a week or so of the caravan ending.

We had started to process people through the gate and 20 orphans (of a group of 60) had arrived from a local orphange for testing and check-ups when all hell broke loose. A couple of men from the regional immigration office in Moshi arrived earlier that morning and asked if everyone had volunteer Visa's. I assured them that we did and that I would bring all documents along with my resident permit and Tanzanian Medical License to Immigration on Monday morning. They agreed that that would be acceptable. It obviously was not....within an hour, the head of regional immigration and 4 of his cronies (one female) and the head of the police (avec Tanzanian Paddy wagon ) arrived at the center. They got out and the small man with the uniform started to yell at me to stop everything and shut it down. He then demanded to see everyone's passports (some of which had to be retrieved from the hotel in town). The chief of police was informed about why we were here and that we were all here legally with appropriate permits from the Tanzanian High Commission in Ottawa. He took a look around and told the immigration officials that they should not be harrassing us. He could see nothing wrong with what we were doing. He got in his truck and left after giving me a look of sympathy.

We then set about collecting passports and they were taken by the group of officials who started to go through them and write down information from each one. After about 30 minutes they told me to come to the immigration office in town and I followed them in the KWIECO vehicle. They told everyone to stay at the center. By this point Mama Selikana, KWIECO's accountant and second in charge when Mama Minde is away, had arrived and was also trying to negotiate with the officials. She accompanied me to immigration and called her friend who is a lawyer and asked him to meet us at immigration. Too bad Mama Minde was in Zanzibar at a meeting. Incidentally she was on her way home to Moshi when this ocurred. Someone had texted her and she somehow go the message that the Wazungus (white people) had been beaten! I waited at Immigration for 2 hours while Mama S did the negotiating. They had an issue with my resident permit (which I carefully renewed in February of 2008) but they were unable to find the file at first (ie. didn't even look for it). It was eventually retrieved and they realized that I was also legal as were all the volunteers on their list. The sticking point was that were needed another permit (not true) and by not having that permit, we were subject to a fine of $400 US each! Mama S was negotiating that issue and ultimately paid a bribe to make that issue go away. We had our documents returned to us and a relieved group of volunteers went to email their families. The day was a bust in terms of patients. We saw less than 30 by the time everything was shut down. They will all be back Monday. We did get to see the first group of 20 orphans. 1 was HIV positive. A man that we tested on Wednesday (who was positive) practically carried his sick wife to the gate along with their children. We let him in and she tested positive and was treated for a number of other ailments and referred for a free CD4 cell count at the government hospital HIV clinic. HIV care is free in Tanzania. But, it is getting people tested and willingness to follow-up with care that is the challenge...all related to stigma.

There was another issue with our medical registration as a group that needed some sorting out on Friday but that is a whole other story. I had to also spend some time with the regional officer for health. He was very helpful and no bribes were paid. Needless to say, we sorted it out because there is a lot of good will on the part of most Tanzanians to have us here and support us. By the end of the week the women's center will be officially registered as an independent health facility in Tanzania!

We all blew off steam on Friday night with the group going to Glacier, and outdoor pub. Dialo, one of our triage translators is the lead singer in a reggae band. He was terrific. We danced and partied until late. I am sure many of the volunteers had heavy heads the next morning as they departed for their 2 day safari to Lake Manyara and the Ngorogoro Crater National Parks. They return Sunday night and we are back on track for Monday at the center.

Thursday, April 24, 2008

Wednesday 378!

Wednesday 378!!!!

It was an exhausting day. We arrived at the center in the morning to a long line up of moms and babies. We closed the gates before 10 am and told those who we could not let in to return on Friday. In the end, we had let in 378 people. We worked as efficiently as possible to get people seen and we had some interesting cases. We don’t have our stats for the day with respect to the number of HIV tests and counseling we did. We seemed to have fewer positives but it may be because we had so many more people. We had a few heartbreakers though with a ‘bibi’ (grandma) coming with three young children. There were twin boys and a girl. They were so cuddly and huggable and crawled all over Wendy Anderson and I for half an hour while we saw them and she tested them. Unfortunately one of the twins was positive. The others, thankfully, negative. The bibi then told us that the mother of the boys was dying of AIDS and that several of her other children had already died. She had 7 orphaned grandchildren. We invited her to come back to the center for some extra support when the caravan was over.

The mosquito nets have been highly cherished items. Thanks to our donors who made the nets possible….you know who you are. We have almost run out and will purchase more tomorrow. Our visit with each client is just a few moments to counsel them on health issues and give out some meds (everyone gets de-wormed…anemia and malnutrition are closely related to the presence of worms here and worms are common..en masse de-worming is one of the useful public health initiatives we can provide). The nets however, are a lasting preventative measure to prevent malaria in young children and pregnant women, the two groups who are most likely to have severe disease and die.

Jenn’s children, Sid and Adam brought a thousand toothbrushes donated by Madeleine de Roybon school and Empire Life Financial and the Emergency department at Kingston General Hospital. They are a huge hit…the kids and adults will brush if they have one!

On a sad note, one of our many translators asked to be tested yesterday at the end of the day for HIV. She is a young woman who is aspiring to be a teacher. She is positive, and we are devastated…..but, we vow to support her through this and she will hopefully turn to Agnes or Sekunda, two of our women’s center employees, who are living productively with HIV.

Caravan Day 1-smiles galore








We've had some changes from previous CACHA caravans to consider as we were seeing only women and children and providing HIV testing and administering a survey looking at our client demographic and HIV knowledge. Monday started off slowly with women and children trickling through from 8:30 am. The slow start was great as we were able to get our feet wet. Marietha Moshi, on of my favorite translators from last year’s caravan said, ‘do not worry, Dr. Karen, the women will come, they will send their brave friends here to see what this is all about. They will come in larger numbers on Wednesday, you will see.’ All told, we saw 174 women and kids the first day!! We performed 88 HIV tests and had a 15.7% prevalence rate (the Tanzanian rate cited by the government is 6-7%!). There is something special about bringing women together and providing a safe environment that leads to a greater willingness to be tested. The government here has had a powerful campaign about ‘knowing your status’ and I think that has been very successful. That being said, very few women are even willing to look at the condoms that we are trying to give out!! They look down, say no, giggle….we clearly have an uphill battle….

Tuesday orientation
We had a ‘down day’ today that was still quite exhausting. We went to the center for 10am and met with Mama Agnes Urasa who spoke to us about the social welfare system and what they ‘try’ to do for those in need. She is an excellent speaker and truly dedicated to her job. She is also the chairperson for KIWAKUKKI. KIWAKUKKI is an amazing organization that was founded in the early nineties by women who wanted to learn more about HIV and help to prevent spread. They now have a number of programs whereby they can support people living with HIV/AIDS (PLWHA’s) in their homes with home-based care. They provide financial support to mothers with HIV with assistance with school fees. They have a small office in town staffed by volunteers where people can seek information and receive testing. They do community outreach and education. They are mainly volunteer based with HIV positive and non HIV positive members providing support. After that we broke into groups and worked with the translators to make up health information sheets in Kiswahili that we will hopefully have finished by next week. We’ll keep copies on file for use within the center and future CACHA caravans. Our topics include reproductive health, HIV/AIDS, nutrition, fatigue(anemia/TB?HIV), malaria, tuberculosis, diarrhea, dehydration, alcohol abuse, grief, menopause and others. We realize the literacy rate is low but we have tried to keep them at an elementary school to early high school level. Health information is hard to find here and many people know very little about their bodies. Through health education we hope to empower women further. Understanding your body and how it works is something that we tend to take for granted (especially working in the health care field).

Anonymous thoughts from the volunteers…
1. ‘My first day was incredible and eye opening. The first case was so sad to me as an elderly woman said she could not afford her medicine and she had HIV. She and I fought back tears as she spoke. As the day went on there were many interesting stories to hear. Some people came to get a check up. The children were beautiful and the women so kind. I am so happy to be part of this fantastic team….
2. ‘What a wonderful way to experience Tanzania. The women’s centre is a beautiful place with terrific ‘grounds’. The food is delicious! It is a privledge to have women share their concerns with us and it is fun to work with a local translator.’
3. ‘My impressions of the first day include sore feet, swollen legs and the man ‘asante sanas’ (thank you very much). Tanzania is beautiful, green, and poor.’
4. ‘An incredible accomplishment from the first creation. The women and families of Moshi will be enriched for years to come. An honor..’
5. ‘This is a whole world away from pediatric emergency care in Canada. I am humbled at the things that women live with here..’
6. ‘I made it ! And I am not talking about the 28 hour flight but the 11 years of my African dream. Finally I did something about it and my first day at the women’s center when this little boy gave me a hug and said ‘asante’, thank you so much to you little guy. So far I am still trying to take it all in, I know the experience will be life changing and I want to enjoy every minute of it. Asante sana Karen for your amazing inspiration..’
7. The first day, a little apprehensive not knowing what to expect! It was great. The smiles on the kids faces when we gave them a sticker on their hand was a reward for a job well done.
8. ‘The mission is amazing…the medical clinic days are the heart and soul of the compassion that I had hoped to be part of..’
9. 'This was one of the happiest days of my life. Just being a part of helping the women and children and even some dads...such an overwhelming feeling. They are very appreciative and are happy...I am so proud to be here!'

Inaugural Women's Health Caravan 2008

The women’s caravan ‘team’ officially arrived in Moshi on Saturday evening to a heavy rainstorm that is typical of the rains we have seen in the evenings during Tanzania’s long rains which run from the end of January until late May. We have been extremely lucky with the weather during the day so far. It has been hot but not terribly humid. We are 22 volunteers and MANY supporters on the group who live here locally. Everyone is truly dedicated. Our own volunteers had to spend or raise up about $4000 to make the two week trip to miss time at work and work long hot days!! Thank you to you all, we could never have gotten here without you.
We have 12 translators and two drivers and several other important people such as Agnes and Vicky, who have been keeping everything afloat at the women’s center for the last 6 months. Prior to our arrival, the center’s outreach programs have been going well, expanding slowly with several women utilizing the shelter. Our most recent tenant has been there a month. She is a young woman with HIV who as a 14 month old child. She was ill and now pregnant with a second child and had basically given up on life due to difficult circumstances in her home. Her husband was an abusive drinker and they were living in extreme poverty. She had left her child at her village home and travelled to Moshi and was sleeping outside under a tree at the social welfare office for days prior to Mama Agnes Urasa (who incidentally did our home study for our adoption of Malinga which is STILL being processed) brought her to our center. We were able to provide her shelter and social support. By fate she delivered her second child on Saturday morning, the day we arrived. She named him Charles and we won’t know for 18 months if he has HIV. The testing available here in Tanzania cannot safely confirm infection prior to that age. Agnes and Vicky sent someone to find her other child at her village home after she arrived at the center and he was found lying naked and unable to sit up on a mattress in her home, with no adults to be found. His name is Charles and he is also too young to test his HIV status. He is thriving at the center with his nutrition improving significantly and he now smiles and is able to sit up (which a baby can usually do at 6 months). Her new baby was taken on Monday to a regional orphanage because she cannot care for both and cannot breast feed the new little one as she is HIV positive. She will not be able to afford formula so has no choice but to give him up. Their separation will be for up to one year. At the one year mark she must decide whether to retrieve her child from the orphanage or relinquish him to the social welfare department for potential adoption. The whole process has been heart breaking for her but she has been brave and accepting and for the last day or so seems to be re-bonding with Stephen, her 14 month old, who needs his mother. Her energy is improving postpartum, which is probably a huge factor.

We also acquired another house resident on the first morning of the first caravan clinic day. Once again, Mama Urasa brought a homeless HIV positive woman who has two children that have been relinquished to social welfare and are in an orphanage. She will stay until we can try to find her accommodation. It is not clear yet whether she will ever be well enough physically and mentally to get her children back. She probably has a psychiatric illness, perhaps related to years of untreated HIV. It is unlikely that we will be able to do anything particularly meaningful for her as I don’t think she can really be helped and she can’t stay at the center forever. We will try to locate any existing family and try to convince them to take her in.

Return to Tanzania (again!)


Back to see Malinga

Jenn Carpenter and Sid and Adam and their friend Jess and I arrived in Nairobi after 16 hours of traveling with the news that our flight was delayed. We managed to keep ourselves busy. Then it was off to Dar es salaam with a 1 am arrival and 2 am to bed! The kids handled it better than the adults I think...

The next morning Brooke brought Malinga to breakfast so that we could spend the day with him. Adam and Malinga immediately hit it off. Sid was the big sister of sorts. It was so wonderful to see them together. Malinga had grown and was happy from what I could tell. We spent time with him at the pool at the Movenpick Hotel in Dar es Salaam and then made our way to the orphanage in the afternoon. Sid and Adam had brought a duffle bag of gifts for the kids and I had brought Crocs that had been donated by some families at my church. We also had some craft kits and beads and skipping ropes (also kindly donated by a wonderful family at my church). The soccer balls brought by Sid and Adam were also a hit and resulted in a busy game of soccer. Issakwissa, Malinga, Sid and Adam played for almost an hour. It was hard to leave for the airport at 4pm but Malinga seemed satisfied when I told him I would be back in two weeks. He seems to fully understand that we are his special family now and that we want him to come to Canada. The other children at the orphanage seem to know as well.