Back in Bujumbura

After 2 weeks out in Kigutu at the VHW clinic, I have plenty to write about. For starters, nice to hear from a few of you, and nice to hear the Sox are back in first place. A lot of headway has been made over the last many days, including the official signing of a public/private partnership convention by the Burundi Ministry of Health. Deo has been trying to accomplish this for many months, and it is a huge accomplishment. As I understand it, this document essentially validates our clinic's partnering with the public health infrastructure in Burundi. By doing so, we are able to add to the current health care system, rather than ultimately draining resources from one area of the country to bring them to another. Now that this is signed, VHW may have future access to a great deal of international support such as UNICEF for our budding vaccination and malnutrition programs.

One of the bonuses of staying in Kigutu last weekend was that I was able to catch the local soccer game between the home team and the next town down the hill, Mugara. Happy to say the home team prevailed in overtime, with a goal by one of our nurses, Sincerite! This pic is during halftime, one of the local kids taking shots. During the game, I found that more of the fans were watching me than the game. A bit unnerving, but I've kind of gotten used to it by now I suppose.

We have a few inpatients with TB that we are trying to settle on treatment regimens for. One is a 70 year old guy who was treated a year ago with standard RIPE, had improved symptoms, and did not follow up. Despite completing the treatment regimen, he showed up a year down the road with a new cough and a completely different chest X-ray. Check out the left upper lobe infiltrate that is causing so much lobe collapse as to pull the trachea (and entire right lung field) to the left. His cough is dry and sparse, so we induced sputum with aerosolized hypertonic saline, which is hopefully now on its way to Boston for culture and sensitivity. . . Time will tell. This process involved waking up at 5AM, inducing the sputum, jumping in the pickup along with another possible TB pt (in back), heading to the nearest local hospital for her to get a CXR and sed rate, rendezvous with our other vehicle, which took the sputum to Bujumbura, where Deo was waiting to carry it with him on the plane to Boston. We need the sensitivities to decide whether to use a retreatment regimen or treat for MDR TB.

So all the photos below are from a field trip we took last sunday. Remember that kid with the burn from last post? Turns out he's got some good 3rd degree burns. After a few dressing changes, dad took him home against our advice. Mom is pregnant, dad needs to work, and there are about 7 kids. So after a few days, we decided to go find him. We had been doing dressing changes w/Ketamine and sent him home w/an IV. The pics, starting from the upper left and going across are:

1) Our backpack contents (first aid, water, food, etc)

2&3) Dr. Dziwe and Deo's Brother, Pacifique hiking to the boy's home

4) Our guide and VHW employee, Didas

5) Didas's family that we hiked by after about 2 hrs (he is at work at 7AM every day. . .)

6) Young boy carrying water home from way down in the valley

7) Me, sweaty and burned

8) Some dude who came out of the woodwork when he saw us, complaining of arthritis (note the baggie of Vitamin I he is now clutching. . .)

9) My artistic side

So after about 3 hours, we reached our destination. No wonder they weren't so excited about trekking back and forth for daily wound care. The IV was out, bandeges off, and the burn was covered in pus and dirt. After a cleeaning, we were able to devise a plan where Didas would bring the boy every 2 days for wound care. More photos:

Same order:

1) Part of our patient's family (about half)

2) When we arrived, I think mom

was a bit embarassed and immediately started to wash him.

3) Drinking our codeine/tylenol concoction pre-cleaning

4) Budding infection

5) Family watches while we scrub

6) Post cleanse-
7) Finishing while Pacifique looks on

8) Walking home

9) This truck from Bujumbura back at the site arrived with all our supplies from storage to be unloaded.

Anyhow, I doubt anyone has actually made it through this. but if you have, gold star. Dziwe and I are off to visit one of Deo's great aunts in a local hospital. Hope all are well.

At the risk of stating the obvious, my time here has certainly made me reflect on how much we all have in our fortunate lives back stateside. If it has made a few of you do the same, maybe my foray into technology is worthwhile after all-

Scott

Crazed soccer fans------>

Saturday at Sun Safari

Whatup. This is me getting techie and trying to make a blog. I have a few free hours, so I thought I'd upload some photos. I am typing from the rooftop deck of an upscale hotel called Sun Safari in Bujumbura, Burundi (one of the few places around with wireless. I just ordered some fish, which came from the nearby lake, and lets just say it was completely intact when it arrived on my plate. Eyes, skin, bones, tail, head, yup.

I'll try to update this from time to time, feel free to check it out and hit me back.

So I've been in Burundi for about 2 weeks now. Most of the time has been spent in a pretty rural location, a town called Kigutu, which is Deo's hometown (for anyone not familiar w/Deo, he's a classmate of mine from DMS who is currently taking working full time to get a community-based health center/hospital off the ground in his hometown of Kigutu, Burundi. Such a project faces numerous challenges. Currently, some of the biggies are a major gas shortage in Burundi and a broken generator and thus no power on site. There are numerous tricky nuances of navigating the appropriate channels to establishing such a clinic in rural Africa, particularly in order to do so in collaboration with the existing system. It is imperative to set everything up with appropriate governmental approval so that the clinic will be supported down the road.

So these pics are a few from the trip thusfar. The kid you see in the photo came in late at night after being pushed into a cooking fire accidentally, and we debrided his hand by headlamp with Ketamine conscious sedation.
The close-up of the burn is actually about a week later, with some nice granulation tissue forming, but also some areas of 3rd degree burns which may require grafting. Not sure what channels exist for that here, but we're exploring with the help of some friends at Partners in Health in Rwanda. The two guys in scrubs w/me are Dziwe and Melino, the two docs at the clinic. Dziwe is U.S. trained in Emergency Medicine, and Melino is Burundian trained as a GP. They don't do a residency here as far as I can tell, and begin practicing right after they graduate.



















The pics to the left are of the clinic from the outside. It is a gorgeous setting up in the hills at about 1700 meters, overlooking the giant lake Tanganyika. Congo is across the lake. At night, fishermen with lanterns dot the lake and it actually looks like a city. The flag you see is the Burundian flag.


All of the stonework and landscaping has been done by the local villagers..



I'm running out of time, so I'm gonna sign off. If anybody has questions or wants to see pics of anything else, lemme know. Hope all are well.


Amahoro (peace)-


-Scott