January 14, 2010 - Yako, Burkina Faso
Actually, it's just after midnight on the 14th and I should be in bed, sleeping. The late evening is the witching hour for me - the time when my energy is spent, when I am the most discouraged. I usually try to avoid writing at this time because of this, but I wanted to try and capture the feeling that I have right now. The trip to Yako today was uneventful. Yako is situated in an extremely dry area - I am told that even in the rainy season it is still relatively dry compared to the southern and western areas ot the country, and that desertification is a major issue. It is very rural and very African, but it is also reminiscent of every rural village that I have encountered. The people are very friendly and are curious about my presence here, but they are quite shy, at least so far. Westerners are fairly common here because of the many international partnerships with my host organization (association Solidarité et Entraide Mutuelle au Sahel or SEMUS, http://www.semus.bf/ ), so I did not feel like I "stood out." Shortly after our arrival in the late afternoon we had a meeting with the head of the department that coordinates community health issues and the HIV testing and treatment clinic, the managers of the various areas, a volunteer from Montreal who has been on site since November, helping with communication issues for SEMUS, the physician who is my liaison while I'm here, and the chargé d'affairs for EUMC. The program for the next two weeks had been worked out in advance, and I was anticipating that this meeting was to ensure that all were informed regarding the schedule of events. It was presented to me in a very detailed manner, outlining formal presentations by all of the organizations involved in health services delivery for the area, an opportunity to visit regional centres, and time with the physician during his clinics. I was then asked for my opinion. "What the heck do I know?" I asked myself. The discussion had been rife with acronyms and abbreviations with which I am still not familiar. I had no concept of how health care services were delivered and little knowledge of the community and customs. I had no objection to the plan so I thanked them for their efforts and agreed to proceed. It was at that point that the EUMC chargé d'affairs informed the group and reminded me that prior to our departure, Pierre Allard had asked for a day in Ouaga at the end of the mandate in order to review the observations and outcomes from both sites. She also made other suggestions that threw everything out the window. I had been told that such things did not happen in meeting in Burkina. I felt like a fish out of water while I attempted to follow the discussion. Thank goodness the young man from Montreal would frequently catch my eye, as if to reassure me that he knew how I felt. Eventually, a plan was set in place and although I was again asked for my opinion, I had nothing to add. My Montreal friend suggested that we take some time for orientation the next day and went home, and the rest of us walked a few metres up the road to an outdoor cafe that consisted of a few old outdoor tables and chairs in a dusty lot next door to the very basic building that housed the kitchen. There were a few light on in the buildings but where we were sitting it was very dark (now I felt like I stood out!). We ate grilled chicken and French fries from a communal plate, talked about football (soccer) as there is a major tournament underway in Angola right now, as well as local, national and African politics - all topic that I am famous for knowing nothing about.
Earlier in the day I had been shown my room in the "centre de hébergement." It was very hostel-like: small, with a bed, a desk and a chair, as well as a bathroom with a toilet (no seat), a sink and a shower. It was not until I returned from dinner that I realized that they had been working on the plumbing but had forgotten to turn the water back on. As well, my bed had only a single sheet covering the mattress. I'll be sleeping under my emergency airline blanket and I'll be scruffy-looking when I show up for work in the morning.
I am feeling defeated, but I remind myself that I know that it would feel this way. I hope that by tomorrow I will regain my enthusiasm and confidence.
I apologize for the stilted writing style that results from not being able to use people's names. As this is a public site I am obligated to not use people's names without consent, and I am way too tired to make up fictitious ones. Maybe next time.
The video is a view from the gate looking in to the SEMUS compound.
Saturday, January 16, 2010
Arrival in Burkina
January 13, 2010 - Ouagadougou, Burkina Faso
Everyone who undertakes a long voyage has to complain about it for a while, so here goes. It was 30 hours of waiting, sitting and trying to sleep in uncomfortable positions. But we made it without any serious incidents (except getting taken by a mime at Charles de Gaulle Airport - maybe some other time) and so did our baggage.
We spent our first day here with the team at Uniterra in Ouaga. We had a chance to tour the city, and we are finally just beginning to understand the context in which we will be trying to get our projects underway. It is difficult to comprehend how few resources there are in Burkina for so many people. Still, the people are extremely pleasant, helpful and full of humour. The name of the country means "The Land of Men with Integrity" and the Burkinabé live up to their name very well (although the women have just as much integrity as the men). It has been delightful to meet the managers of the program here, but also to have a chance to speak to many ordinary people about their lives and also how HIV has affected them. No one understands when we discuss the issue of palliative and end of life care (there just isn't any) but everyone will tell you how HIV has affected their lives because of someone they know.
Today, we leave for our project areas. Pierre Allard is off to Bobo Dioulasso (the second largest city, in the western part of the country) and I am heading to Yako, a town in a rural area about one and a half hour drive to the north.
Everyone who undertakes a long voyage has to complain about it for a while, so here goes. It was 30 hours of waiting, sitting and trying to sleep in uncomfortable positions. But we made it without any serious incidents (except getting taken by a mime at Charles de Gaulle Airport - maybe some other time) and so did our baggage.
We spent our first day here with the team at Uniterra in Ouaga. We had a chance to tour the city, and we are finally just beginning to understand the context in which we will be trying to get our projects underway. It is difficult to comprehend how few resources there are in Burkina for so many people. Still, the people are extremely pleasant, helpful and full of humour. The name of the country means "The Land of Men with Integrity" and the Burkinabé live up to their name very well (although the women have just as much integrity as the men). It has been delightful to meet the managers of the program here, but also to have a chance to speak to many ordinary people about their lives and also how HIV has affected them. No one understands when we discuss the issue of palliative and end of life care (there just isn't any) but everyone will tell you how HIV has affected their lives because of someone they know.
Today, we leave for our project areas. Pierre Allard is off to Bobo Dioulasso (the second largest city, in the western part of the country) and I am heading to Yako, a town in a rural area about one and a half hour drive to the north.
The photo is of the EMUC/CECI offices in Ouagadougou.
Saturday, January 9, 2010
Leaving for Change
My name is Martin LaBrie, and I am a palliative care physician as well as an HIV treating physician living in Calgary, Alberta. I will be leaving January 10, 2010 to travel to Burkina Faso in western Africa as part of a project developed thorugh the Canadian Medical Foundation that is intended to enhance the capacity to provide palliative and end-of-life care for people living with HIV. I will be working with l'association Solidarité et entraide mutuel au Sahel (SEMUS) in Yako, Burkina Faso for the next three weeks.
The Canadian Medical Foundation (CMF) has partnered with Leave for Change (L4C) to deliver our international volunteer program. The program enables volunteers to participate in a two- to four-week volunteer assignment in a developing country. L4C is a component of the Uniterra Program, Canada’s largest international volunteer cooperation program, funded in part by the Canadian International Development Agency (CIDA) and implemented jointly by World University Service Canada (WUSC) and the Centre for International Studies and Cooperation (CECI).
In January 2010, the CMF is supporting six physician volunteers to go to Malawi and Burkina Faso to provide volunteer services in the area of palliative care as it relates to HIV/AIDS. More details regarding the project, the physicians who will be volunteering in Africa, and the Canadial Medical Foundation can be found at their website, www.medicalfoundation.ca.
Through this blog I intend to keep a record of my role in the project. I became involved with caring for individuals living with HIV early in my medical career. In 1983 I started a practice in family medicine in Calgary with a focus on palliative care in the home setting. The first diagnosed case of AIDS in Calgary was diagnosed that year, about four years after it was first described in the U.S. I saw my first patient living with HIV in 1985, and for the next decade I was involved in the care of very many individuals who were living and dying of AIDS. It was an extremely difficult time for me but those people taught me a great deal about living with a life-limiting illness. HIV disease is unpredictable, protracted, and affects every organ in the body. My palliative care experience to that point had primarily involved treating people with various forms of cancer. Cancer usually follows a fairly predictable course when it cannot be cured, with gradual progression leading to death that can be forseen weeks or even months in advance. The goal of palliative care was to ensure that pain and suffering were managed as well as possible during this disease trajectory. AIDS changed all that - now people were living for years with few or no symptoms, waiting for the ticking time bomb in their bodies to go off. When they did become ill, they often would manifest several medical conditions at the same time. Often we would expect people to be close to death, then see them recover dramatically, although temporarily. What impressed me most about these people was the sense of survivorship. At the time, these individuals were primarily young, previously healthy men who had not been contemplating end of life issues. The focus was on using every possible means to stay healthy for as long as possible, and to live each day. No one could tell these people to sit around and wait to die. It was a lesson that I took to the care of all the people I worked with who were confronting advancing disease, focusing on hope and life worth living no matter what was happening to them.
In 1996 everything changed with the development of effective treatments for HIV. We were now able to supress the growth of the virus, allowing the immune system to heal in most cases and preventing progression of immune system damage in those who were still not yet injured by the virus. It was a dramatic time, and at the time I likened what I was witnessing to people being released from a concentration camp, going from thin and weak to healthy and robust over a matter of weeks. Since then I have continued to be involved in HIV treatment for those who have the ability to adhere to complex treatment regimen and close clinical follow up. Palliative care in my world now involves individuals who are unable to access treatment because of other determinants of health such as chronic homelessness, Hepatitis C co-infection, addictions, mental illnesses, and other conditions that tend to marginalize some of us in our society.
Going to Burkina Faso means going back to the old era of HIV treatment. Burkina Faso has just under 15 million people. Almost 50% of the population lives on less than $1US per day, and most live on subsistence agriculture. Infrastructure for health care delivery is very limited, with very few doctors or nurses. The incidence of HIV infection is estimated to be between 5 and 10% of the population, and 8000 HIV-related deaths occur each year. This is in addition to the many other health issues such as tuberculosis, malaria, typhoid fever that people have to deal with. Health care has been a priority for the government of the nation, and the goal is to achieve universal access to HIV treatment. The country has extremely limited resources, however, and only a few thousand individuals have access to any HIV drugs.
I am very anxious at the prospect of trying to help people deal with a complex illness with very few tools available. My role will be to assess how care providers have confronted this problem to date, and advise regarding ways to enhance their capacity. I am certain, however, that I will be spending most of my time learning from caregivers who have had to make do with very little, yet still are responding to the needs of those in the community who are suffering. Maybe what I learn can be translated in to a better response from the disadvantaged individuals suffering from HIV in my own community. I hope that we all can learn together.
The Canadian Medical Foundation (CMF) has partnered with Leave for Change (L4C) to deliver our international volunteer program. The program enables volunteers to participate in a two- to four-week volunteer assignment in a developing country. L4C is a component of the Uniterra Program, Canada’s largest international volunteer cooperation program, funded in part by the Canadian International Development Agency (CIDA) and implemented jointly by World University Service Canada (WUSC) and the Centre for International Studies and Cooperation (CECI).
In January 2010, the CMF is supporting six physician volunteers to go to Malawi and Burkina Faso to provide volunteer services in the area of palliative care as it relates to HIV/AIDS. More details regarding the project, the physicians who will be volunteering in Africa, and the Canadial Medical Foundation can be found at their website, www.medicalfoundation.ca.
Through this blog I intend to keep a record of my role in the project. I became involved with caring for individuals living with HIV early in my medical career. In 1983 I started a practice in family medicine in Calgary with a focus on palliative care in the home setting. The first diagnosed case of AIDS in Calgary was diagnosed that year, about four years after it was first described in the U.S. I saw my first patient living with HIV in 1985, and for the next decade I was involved in the care of very many individuals who were living and dying of AIDS. It was an extremely difficult time for me but those people taught me a great deal about living with a life-limiting illness. HIV disease is unpredictable, protracted, and affects every organ in the body. My palliative care experience to that point had primarily involved treating people with various forms of cancer. Cancer usually follows a fairly predictable course when it cannot be cured, with gradual progression leading to death that can be forseen weeks or even months in advance. The goal of palliative care was to ensure that pain and suffering were managed as well as possible during this disease trajectory. AIDS changed all that - now people were living for years with few or no symptoms, waiting for the ticking time bomb in their bodies to go off. When they did become ill, they often would manifest several medical conditions at the same time. Often we would expect people to be close to death, then see them recover dramatically, although temporarily. What impressed me most about these people was the sense of survivorship. At the time, these individuals were primarily young, previously healthy men who had not been contemplating end of life issues. The focus was on using every possible means to stay healthy for as long as possible, and to live each day. No one could tell these people to sit around and wait to die. It was a lesson that I took to the care of all the people I worked with who were confronting advancing disease, focusing on hope and life worth living no matter what was happening to them.
In 1996 everything changed with the development of effective treatments for HIV. We were now able to supress the growth of the virus, allowing the immune system to heal in most cases and preventing progression of immune system damage in those who were still not yet injured by the virus. It was a dramatic time, and at the time I likened what I was witnessing to people being released from a concentration camp, going from thin and weak to healthy and robust over a matter of weeks. Since then I have continued to be involved in HIV treatment for those who have the ability to adhere to complex treatment regimen and close clinical follow up. Palliative care in my world now involves individuals who are unable to access treatment because of other determinants of health such as chronic homelessness, Hepatitis C co-infection, addictions, mental illnesses, and other conditions that tend to marginalize some of us in our society.
Going to Burkina Faso means going back to the old era of HIV treatment. Burkina Faso has just under 15 million people. Almost 50% of the population lives on less than $1US per day, and most live on subsistence agriculture. Infrastructure for health care delivery is very limited, with very few doctors or nurses. The incidence of HIV infection is estimated to be between 5 and 10% of the population, and 8000 HIV-related deaths occur each year. This is in addition to the many other health issues such as tuberculosis, malaria, typhoid fever that people have to deal with. Health care has been a priority for the government of the nation, and the goal is to achieve universal access to HIV treatment. The country has extremely limited resources, however, and only a few thousand individuals have access to any HIV drugs.
I am very anxious at the prospect of trying to help people deal with a complex illness with very few tools available. My role will be to assess how care providers have confronted this problem to date, and advise regarding ways to enhance their capacity. I am certain, however, that I will be spending most of my time learning from caregivers who have had to make do with very little, yet still are responding to the needs of those in the community who are suffering. Maybe what I learn can be translated in to a better response from the disadvantaged individuals suffering from HIV in my own community. I hope that we all can learn together.
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