More pics for the great LAMU trip!

The Jean Mary, our maiden voyage went well but most of the girls got sick. KT and I were stalwart sailors!!
Local boy swimming
A traditional Swahili door with intricate carving
Playing around for the camera. Mel took these great pics.
NICE speedo!!

Donkey riding takes a little skill. Concentration and balance are required....
...I went for the camera and now I'm losing it......ahhhh...am I gonna fall!?!? Donkey man behind me is on guard...wait wait...
...there it is!! All style and finesse ;)
Muslim girl with pet monkey

Men walking through the streets of old Lamu, check out the nice island man-skirt look
rooftops
Ahhh this man, I forgot his name, apparantly ali-babar, or something like that!?!? We weren't warned against his home cooked authentic Swahili meals for tourists....apparantly you'd end up with an authentic experience in the toilet for the next few days!! Here we found him in the streets hanging out and playing his ...?? keyboard! You know....
Handicraft shop
Donkeys..>AWWWW

My Christmas and New Years!

A belated Happy Holidays to all you out there! I hope yours was an enjoyable and prosperous time with lots of family and friends around. I thought I better finally put up some pics from an interesting trip I took over the Christmas break. Myself and the five other girl interns traveled to an island called Lamu off the North East coast of Kenya!! It was an interesting adventure full of the trials of overland travel in Africa! Lamu is steeped in Swahili history, a mix of African and Arabic cultures and a predominantly Muslim island. For those of you with the time and interest a full detailed account has been written by Laura, a literary genius ;) and fellow intern, on her blogsite lauradevries.blogspot.com! It’s a long but fascinating read and I don’t think I could capture it any better than she has….lets just say it takes a long time to explain!! Look for the link on the right hand side of this page!! And enjoy some of the pictures I am posting here!

We stopped in at the Giraffe Centre outside Nairobi before we caught the train to the coast.

Getting up close and personal while feeding a giraffe at the Centre! They have such long, purple, slimy tongues!!

The train from Nairobi to Mombasa on the coast. Last relic from the imperial British East Africa days, including silver service dinner!



Bryony and Laura getting off the train...stopped a little short of the platform! Happy to finally be on the coast and closer to our destination...or so we thought!



Happy to have found transport and hired this pink/purple matatu, complete with pimps painted on the side, to drive us to Lamu. We didn't know what awaited us!!

...and this is how we felt/looked when we finally arrived at our hotel room in Lamu at 1030 at night! Ok well I thought we were doing the 'frazzled' face for the picture but apparantly we were smiling.Finally some paradis!! KT and I hit the beach.


A donkey ride on Christmas Eve...what could be more appropriate!!

Took a dhow trip on Christmas Day.


Fishing for Christmas Dinner!!! I caught two!! I think the pirate head gear helped!!



The beach where we spent christmas day!!

Our faithful guides prepared us a delicious swahili meal for christmas dinner. Making coconut milk...from scratch!! Using a fantastic shredder/stool that these Kenyans thought up...way to be ingenuitive!!

Some henna art I got done by a local lady. On my skinny feet...hmmm they are weird looking.

Muslim ladies walking throught the streets.

A picture of Exciting Coach (quite literally!) which we were forced to take at the last minute on the journey back from the coast to nairobi after the train tracks flooded.

New Years Eve in Kampala at the bash at the Sheraton hotel grounds. To bad I don't have a picture of when KT and I ran onstage and embarassed ourselves dancing in front of a thousand people!

Highlights of the month!

Here are some highlights of the last month or so, end of November and
December! Just a little update as I go off on my Christmas break and head
towards the Indian Ocean in Kenya for a little beach and relaxation and a
reeeeeally long bus ride! Oh and one low light to mention which was the
loss of our dear colleague Graeme back to Montreal to finish his university
year! Rubingo camp will never be the same without you Graeme! Two months was
too short a time to be here with us and it isn’t the same with only the
girls left, what can I say we miss your masculine presence! Ha ha. Oh and by
the way this blog entry is dedicated to you, Graeme Burrows, and the
omnipresent Burrows Endowment Fund ;) .music is life!

Ok on to highlights:

-attending The AIDS Support Organization\s (TASO) annual drama festival for
the Mbarara region. Getting to see traditional dances, music, and songs as
well as some interesting, and enthusiastic, dramas highlighting the
problems faced by children infected and effected by HIV/AIDS

-white water rafting at the source of the Nile River, and then coincidentally that same
day, having our first visit to a Ugandan nightclub while being filmed for a
travel/tourism segment on the national TV channel. That was a looong day :)
-visiting the local government health centre to spend some time learning
from the nurse/midwife there, feeling for fetal positions in the womb and
measuring the top of the uterus to determine gestational age!

-running an intravenous drip of Quinine, while in the back of a truck as
Graeme manoeuvred over some bumpy ass road, with the solution bottle hockey
taped to the head rest and me counting drips using my cell phone display light! That was my
best MASH 4077 moment and Graeme and I enjoyed it thoroughly

-oh which reminds me of another highlight, the inauguration of medical/music nights! When Graeme and I were the only two white-ies at camp for a few days and spent the evenings listening to his
speakers and learning about medical conditions by candle-light! We covered the clinical stages of
HIV/AIDS and intestinal worms!! Remember, roundworms are big, bad, and can
BLOCK your friggin intestines right off (if you want proof I have a
disgusting picture in my medical dictionary to show you :)

-figuring out I can pee behind Mel's tent in broad daylight with total privacy and no one
seeing me, which means I can avoid un-needed trips to the outhouse. By the way does anyone
else know what to do when your long drop toilet starts to
fill dangerously close to the top?!?!

- finally cleaning and organizing the second room and medical supplies of the
Aid Station!! Thanks to mel for the help!

-Katie's stories about the questions asked at family planning sessions!
Always good for a laugh.

-And finally...the long awaited visit from my dear friends Nate and Paul
from back home on Arbutus Street! Although they could only spare a few days
away from their schedule doing prep work in East Africa for their new
charity Under The Reading Tree (supporting libraries in Africa!) it was such
an honour and joy t have them come right to my home in Rubingo Camp. I was
very excited to share everything with them so they would know about life
here, and in turn it was great to see our home through their eyes, it truly
is one of the most beautiful places on earth. And a highlight within a
highlight, the slaughter of the goat I bought in honour of their visit and
gave to Paul for his birthday present. It was my first goat slaughter,
fascinating and educational at the same time¡ Here you actually are
connected to where your food comes from. Paul, I am glad I could be a part
of the first time you killed an animal yourself and in your words "finally
became a man¨!!! The feast and dancing that followed was one of the best
evenings we have had in camp and all the workers agreed :)







National Immunization Day



















A traditional instrument being played at the TASO Mbarara District Drama Festival

















Excitement at TASO Drama Festival!! KT, Graeme, Mrs. Nasuna and Moses (Our HIV clients)














The whole crew at festivities for World AIDS Day in the neighbouring district. Me, Rose, KT, Evas, Perez. Unfortunately the hats were the best part of the program!!! It got rained out and was a bit of a dissapoinment or as Evas put it..."Stupid AIDS day"!!










Children performing for World AIDS Day....that part was good.











KT and Graeme having ???too much??? fun.


















Nate hanging out on my tent deck.
















Excitement...before the slaughter!!!

My USB has an STD!!

(sorry this is an old entry from November that never got published yet!!


Yep that’s right, Katie informs me it is called herpegonorrsyphillaiditis!!! Well people that is what you get what you go around sticking it in every internet café computer in town! What a home-hitting lesson to learn on the week of HIV Voluntary Counselling and Testing Day!! You get a virus on your USB…next thing you know the brand new camp laptop has it, someone else’s flashdrive has it, and you can’t get rid of it because there is no internet at camp to update Norton Anti-Virus!!! Anyways the point of all this is to not only introduce my first ACTS HIV testing day experience but also to provide an excuse for my retarded lack of emails and pictures posted as my USB disease tries in every way to thwart me including shutting off the computer RIGHT BEFORE I POST MY PICTURES I SPENT 4 HOURS UPLOADING!!!!!......can you feel the tension?
Ok more importantly, I participated in our monthly HIV testing day recently. ACTS collaborates with the Aids Information Centre (Mbarara Branch) to provide free HIV counseling and testing for anyone who comes to our announced dates! It is done monthly and we facilitate the day by paying for the outreach personnel from AIC (counselors and lab techs) and all the tests for anyone who comes willingly to be tested. This was also a special day as it was the first time children of our HIV positive clients were going to be tested in the field (meaning we didn’t have to pay transport for them to go all the way to Mbarara for testing)!! This was a big deal, a new breakthrough in our partnership with AIC, and also an opportunity for many more children to be tested! AIC was willing to test as many children of our clients as showed up, and provide specially trained child counselors.
There was, to start the day, a little general info session for the people that had gathered (which apparently included…roughly translated….a talk about how bedroom walls should be built all the way to the ceiling instead of halfway so children don’t learn about sex too early because….as our worker Rose pointed out….sometimes you just can’t help being noisy?!?! I guess we don’t have to consider this so much in Canada with insulation, full walls, and all). Next on the agenda…..every person to be tested gets a form from AIC, then sees a counselor before testing to discuss psychological issues around testing/possible results etc. to prepare each person for their test. Then they line up for the lab tech, which is who we spent most of the day watching. He tirelessly and proficiently drew blood from all 99 people before he began to test the serum. We were able to watch him run the tests which were quite simple, drop some serum on the strip and if a bar shows up it’s positive, if not it’s negative. Kind of like a depressing version of a pregnancy test and I have to say it was a strange feeling to watch a bar appear, knowing what it means for that persons life. The first strip of 10 tests we watched three were positive and two were children. Any positives are then set aside and retested using another type of test for verification. I believe at the end of the day 12 out of the 99 people were positive, 8 female and 4 male. I am not sure how many were children. After all the tests are finished and verified each person returns to their counselor to receive their results. We didn’t sit in on this part, I don’t know if many people would like a couple foreign observers when they found out if they have HIV or not! It was a long day but an interesting experience and we had the chance to get to know a few of our clients by name, and even practice some traditional dancing during the waiting time!

Waiting for results to be given out.

RAS

(Evas and I pretending to asses a patient for the camera, in our little Aid Station. It's actually Phiona's doll!!)




(Evas and her daughter Phiona)









Many of my days are now spent at the Rubingo Aid Station (or RAS, as I affectionately abbreviate it) our tiny little two room clinic. In fact it is mostly just one room as the second room had somehow turned into a “store” room. In other words it was piled high with junk and messy cupboards full of various medical supplies! Last week Evas, Melanie and I tackled it, pulling out all the junk and storing it in another building. This also involved the revealing of a mouse who had taken up residence (part of my inspiration to clean) who promptly ran towards the door causing screams and a swift kick in the head from Evas! We made Apollo, the guard, dispose of him in the garbage. A good floor washing and a full day of organizing supplies later it was spic and span, leaving us with quite the feeling of accomplishment!
The RAS is a far cry from working at BC Childrens Hospital that’s for sure. It is basically a small dispensary where we can deal with very minor ailments and illnesses. However much more than that comes to the door sometimes! At times it is frustrating to be so limited in supplies and services, especially when I know the treatment a patient needs but we just can’t provide it! We do a lot of malaria treatment based on symptoms as we have no laboratory facilities. Also minor bacterial/yeast infections, bladder infections and well a lot, a LOT of malaria!! I call it a dispensary because what we offer is mainly oral medication, and that seems to be what people come for. Most people seem happy with some sort of pill, even if the underlying problem goes much deeper. A lot of people also seem to show up either thinking we can do a lot more than we can, or more likely….just because there are white people around they figure they will get help. I spend a lot of time trying to take detailed histories through Evas’ interpreting, and then referring people to other centers, but the problem is this… it isn’t quite so easy as that to navigate the health system here. In fact it has driven me crazy on a few occasions!! For example a mother showed up in Rubingo a month or so ago with a 9 month old baby with severe hydrocephalus (water on the brain). Poor kid couldn’t hold his head up and looked like he was constantly peering over the rim of invisible glasses! Upon further examination it was obvious he had a myelomeningocele, which I have never seen but learned about in trusty nursing school. Part of his spinal column wasn’t formed properly and there was a large bulging mass at the base of his spine where spinal fluid (and likely part of the spinal cord) was just protruding out under the skin. It is a congenital defect, meaning he was born with it. We questioned the mother and turns out it was noticed at birth and she was referred to the “real hospital” better known as the University Teaching Hospital in Mbarara. It is a government centre so treatment is free, when asked why she never took the baby for treatment the answer was that they didn’t have the money for transport to Mbarara (the nearest city, 1 ½ hrs drive). By now the baby had developed the swelling likely due to a blockage in the cerebrospinal fluid circulation and had a head the size of a watermelon. So they were back for help. Obviously there is not a lot we could do but assist them with some money for transport to town. I was reading in a textbook that said surgical treatment of this condition is usually done within the first 24 hours of life! HA!





(One of our little patients! Pretty adorable)






The frustrations are many when people turn up that are beyond our ability to help at the RAS. It is difficult to help them unless you want to pay for everyone’s complete medical care…which we don’t have the funding for. For example let me tell you a story. There is a government run clinic about 30 minutes drive from us, it has well trained medical staff and free medications…..if they are there. Course if you are a patient at Rubingo and you have to walk it’s gonna take about 3 hours to get there, and they’ll give you a prescription, but if they don’t have the medication in stock then your on your own to buy it. In Canada it’s the same except most people have some money at their disposal or a social assistance program. Here it is just another closed door. Even if we DO assist people and drive them to the government clinic sometimes that just isn’t enough. The other day a woman in her 20’s came to us, brought by her elderly mother who was one of our Mutual Benefit Society widows. This young woman could barely stand, she lay on a grass mat outside the RAS. She was skin and bones, I could actually lift her and carry her in my arms like a child. There was also a small baby with the two women, the child of the ill woman. The grandmother explained that the woman had been sick for two months and her symptoms were fever and cough. She looked like she’d been losing weight for a long time, probably had full blown AIDS but she had never been tested. Even more disturbing was the child, once revealed, a tiny bundle of skinny arms and legs with an edematous belly and an awful wet cough. It was the most malnourished child I have seen yet. It had no energy, no shine to its eyes, and looked an awful colour with a pathetic cry. Both Katie (the other nurse) and I looked at the mom and the baby and thought…well they need to go to the hospital!! The child didn’t look like it had long for this world if something wasn’t done, the mother wasn’t much better off. Course we had other programs planned for the day and so decided to pack these in the truck and take them to the government centre where hopefully they could get more assistance, there is a lab there for HIV testing and they have IV capabilities. They also have an “ambulance” to transport patients (ie pickup truck).
Off we went to find some help and, on arriving there, carried the lady into the clinic. Many people were already waiting and we asked which staff member was working today because we had a patient to be seen. Apparently everyone was still waiting for him to arrive! Luckily it wasn’t long and he soon showed up, we explained the situation to him and asked if they could please provide treatment and also an HIV test for this lady. He examined the lady and glanced at the child and told us yes they have a lab to do testing, but unfortunately the lab tech wasn’t in today. When was he coming back?! Well he’s on leave so…..who knows, no lab till then. He started to fill out a referral form for them to go to the Mbarara University Hospital and we asked how they were to get there, could the ambulance take them?! Well no the ambulance was gone, driving the clinic manager somewhere and wouldn’t be back till evening. They had to find their own way…which was almost impossible without any money and two critically ill patients being helped by this grandmother! By now we were just fed up and not trusting that they would get anymore help here we promised to return and drive them to Mbarara Hospital ourselves as KT and Laura had other business there already. Of course when you go to the hospital here you have to bring your own linens, toiletries, food and someone to care for you! So you literally can’t even afford to go to the hospital if you don’t have any money! So not only did we have to drive them ourselves to the hospital door if we wanted them to get treatment but we had to give them money just to stay there!! It’s amazing, if you want to help someone out you end up having to do everything yourself because there really is little infrastructure in the area in terms of health care. In their defense local government staff do the best they can but resources from the government are limited. It is difficult making decisions daily about who to help and who to leave. ACTS can’t afford to pay for the health care needs of everyone person who shows up at camp, we just don’t have the budget. But at the same time it is hard to just help them a bit and then hope they make it the rest of the way, but not really knowing. I guess it is hard to let go of that control over someone’s health care once you start looking after it, especially if you don’t really trust the system in the first place.
Somehow though, people manage to survive, and it is surprising how they find resources here and there when all we hear is “there is no money”. Many people come to the camp looking for assistance with one thing or another. It is quite a challenge learning to determine who has the most pressing needs and who will probably fend for themselves if we don’t step in. It’s the constant struggle of hand-outs versus fostering independence, and trust me nursing gave me little preparation for the issues of international development! We have impassioned arguments among the interns about how we can be most useful here as foreigners and often there is no clear answer. Half the time I am more of a mediator of resources than a health care provider! Everyone has a legitimate need but we can’t meet them all! North America is a perfect example of how everyone has a need they would like met if you offered, no matter how much they have!! Here it is just more culturally acceptable to show up and ask for what you want if you think someone has it! Human beings never seem to be satisfied; but no matter what the story is at the end of the day I am always better off, for reasons of money, education, experience, or opportunity, than most of the people around me. Hopefully the lesson that is to be learnt in this reality won’t be lost on me.





Gorrette, one of the widows in our Mutual Benefit Society gardens and the first HIV client of ACTS. She was resposible for making ACTS aware of The AIDS Support Organization (TASO) which lead to our HIV/AIDS client program and a partner with TASO. She was very sick at one time, near death, until she got put on Anti-Retroviral Therapy and she is now looking strong and healthy.





Doing hoome visits with Perez, Evas, Melanie and Katie. Both the women in the middle of the picture below are our HIV clients.


















Visiting with one of our HIV clients at her home. The woman to the left of me is an HIV positive widow who has seven children of her own and cares for another orphan who is also HIV positive (and one of our clients)...the young girl second from the right, Rachel. This woman had a wonderful garden with beautiful sunflowers which I don't see often here! Oh and one of her kids names was George Bush!! HA HA

Melanie and I dressing up African Style with our new dresses from Alice the Seamstress!!