Susan Boiko, MD, Blogs from Rwanda: Food, or School?

Note:  Susan Boiko, MD, is a Kaiser Permanente dermatologist in San Diego. She’s arrived in Bwiza, Rwanda,  to perform relief work in support of the Pygmy Survival Alliance, a collection of nonprofit organization that connects pygmy villages in Rwanda with information, leadership, survival and health resources to enable them to transform their health and welfare.

Sept. 12, 2011

How different things are a year later! As we got off our motorcycle taxis after a speedy ride up the mountain via a vastly improved dirt road, a handful of children dressed in school uniforms came to greet us with hugs and happy cries.  Last year, only one or two children were attending school. The gentleman whose house we are living in, Innocent, asked them, “How many of you have not eaten today yet?” All raised their hands. A schoolchild faces a hard decision every day: Go to school, and when you come home, all the food is eaten, or miss school and eat. Our dinner table conversation last night revolved around how to support these children. One thought: a school breakfast or lunch program for all students.

Susan Boiko, MD

Hernando Garzon, MD, Returning to ‘Work From Home’

September 11, 2011

About to start a LONG journey back.  more work to do, but it will be from home. In the meantime, programs in Somalia are underway, and in Kenya are under development.

Many things give me hope when doing this work.  on this trip, some of those things are pictured here.  Many,  many thanks for all your support!

Peace,

Hernando Garzon, MD
Kaiser Permanente Sacramento Medical Center

Hernando Garzon, MD, Blogs From Mwingi: Three Days in Rural Kenya

September 8, 2011

I returned late last night from three days in rural eastern Kenya, doing a needs assessment in the Mwingi district about 80 miles east of Nairobi.  We visited about 8-10 health clinics and dispensaries, and a few district hospitals.  The population there frequently travel 5-10 miles daily just to find water. Dispensaries or Health Clinics are often up to 15 miles away from remote villages.  As usual, the need is so great, one of the hardest decisions is choosing where to start.  the Ministry of Health runs the existing health facilities, but they are amazingly understaffed and under-resourced.  Possibilities for our involvement in this district include developing an outreach program to access the distant villages, and to develop some clinical staff training around nutrition (capacity building).

Here are some of the photos of our two days there, and will hopefully give you a sense of the environment and the beautiful people here.

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Today, three  of us had the opportunity to visit the U.S. embassy and meet with Ambassador Jim Swan, who has been named the special envoy for Somalia.  Relief International has a private meeting with him as we are one of the few U.S.-based NGOs with fairly extensive operations there.

I only have a few more days here, but expect to continue helping to develop programs here.  We have 4-5 different grant proposals into various donors (UNICEF, OFDA, WFP, etc.), and within the next month expect to establish additional programs in Somalia and Kenya.

Thank you all for your support and kind words!

Peace,

Hernando Garzon, MD
Kaiser Permanente Sacramento Medical Center

Hernando Garzon Blogs From Kenya: Five Minutes, Five Images, from the Kibera Slum

September 6, 2011

I have 5 minutes for an update!

My planned trip to Somalia was first delayed, and now canceled, as there has been an escalation of fighting in the Galcayo area, and we’ve reports that up to 50 percent of the population is fleeing.  We’ve evacuated the two non-Somali staff to a safer location.  Review of that program will unfortunately have to be from a distance.  We still have national staff working in that program, and are extending into other areas of Somalia.  The existing program in Galcayo has seen more than 15,000 patients and immunized close to 2,000 children.

In Kenya, we are still developing two areas of possible involvement.  In a few minutes I’m off to the pastoral district of Mwingi to assess needs for health and nutrition support there.  We are also still looking at opportunities to get involved in urban ares – the slums in Nairobi, and the doubling/tripling of food prices has many families down to one meal a day and malnutrition rates climbing.

The attached are photos from an assessment of the Kibera slum, the largest in Kenya.  I believe the greater good would be served if everyone from a developed country had the opportunity to spend such a day in Kibera – just to see firsthand how others have to live.

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More later.  Peace,

Hernando

Hernando Garzon, MD, in Nairobi: Shocking Conditions in an Urban Slum

Sept. 1, 2011

All,

I worked in the Mathere slum in Nairobi for a month after post-election violence in 2008, and visited again in 2009 (when working in western Kenya). One would think that after such time here, I would be “used to it.” It is, however, still shocking to see the conditions under which our fellow humans live.

While so much of the media coverage of this Horn of Africa drought/famine shows malnutrition and famine in Somalia and the refugee camps in eastern Kenya and Ethiopia, it’s clear that there are other areas in both Ethiopia and Kenya which are also affected by drought and malnutrition.  What is also not well reported is that malnutrition rates in the slums in urban areas are also increasing — food is available, but people cannot afford the higher food prices. Rural malnutrition rates of 10-15 percent may sound worse than urban malnutrition rates of 2-3 percent, but consider this: That malnutrition rate of 15 percent in the rural areas may represent 3,000 children, but the urban rate of 3 percent may represent 12-15,000 children.  Because of this, we are also evaluating the needs of urban slum environments, and this is what prompted today’s visit, and the attached photos.

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Perhaps my most surreal experience of the day happened while walking through Mathere, when I saw a young man I had taken care of during the post-election violence here in 2008.  I recognized him first because of his amputated right arm, which he lost as a result of a traumatic machete attack 3 years ago. In contrast to the look of fear and terror which I remember so well in his face, and which was so common in all our patients here 3 years ago, he had a smile, looked at ease, and looked healthy. It was wonderful to speak with him, and amazingly heart-warming to see such a positive outcome.  Those few minutes reminded me how the efforts made to work in these environments is so worth while.

In other news, Relief International is proceeding with expanding the existing nutrition and health program in Galkayo, Somalia.  The plan is to develop a Maternal/Child Health program and a malnutrition program in Matabaan, a town about 70 miles south from Galkayo, in central Somalia.  While not visiting this site, I am helping to organize that program.

Thank you for reading.

Hernando Garzon, MD
Kaiser Permanente Sacramento Medical Center

Hernando Garzon, MD, Arrives in East Africa; Helping the ‘Bottom Billion’

August 27, 2011

For those of you who may not be aware, I am working with Relief International doing a needs assessment and program development for a humanitarian response to the drought/famine in East Africa.

I arrived safely to Nairobi a few days ago, and expect to be here for just under three weeks.  I expect my work to be focused on Somalia and Kenya, although Ethiopia remains a possibility. Relief International has had an existing nutrition and health program in the city of Galkayo, Somalia,  since 2007.

Galkayo is in central Somalia and at the edge of the areas currently declared in famine.  Recent reports estimate a seasonal crop in Somalia this year of only 17 percent of the past 10-year average.  For this and many other reasons, the famine is expected to spread before it gets better.  My work in Somalia will be based on looking to augment the existing programs there in nutrition and health, and we are already underway in establishing additional funding from UNICEF to do so.  My work in Kenya will be around evaluating areas that are affected by drought and considered high food insecurity areas, and are currently felt to be under served by international NGOs.  We hope to establish health and nutrition programs in Kenya as well.

After a few more days to get my bearings, connect with contacts and attend meetings in Nairobi, I expect to spend time in the field, both in Somalia and in rural areas of Kenya.

The attached photo is from a recent assessment in the Dadaab refugee camp in eastern Kenya.  With more than 12 million people at risk of starvation, this crisis is magnitudes larger than other disasters which have seemed large to us, including the Haiti earthquake, the Japan earthquake/Tsunami, the Southeast Asia Tsunami, etc.

The people affected by this crisis are already amongst the “bottom billion” – those poorest of us, all of whom are living on less than $1 a day.  Thank you all for supporting my work here as it is a contribution to the large scale effort which is needed to save lives and alleviate suffering.

Hernando Garzon, MD

Susan Boiko, MD, Upon Departing for Rwanda: If It Isn’t Yellow, Will They Let Me In?

Note:  Susan Boiko, MD, is a Kaiser Permanente dermatologist in San Diego. She is about to leave for Bwiza, Rwanda,  to perform relief work in support of the Pygmy Survival Alliance, a collection of nonprofit organization that connects pygmy villages in Rwanda with information, leadership, survival and health resources to enable them to transform their health and welfare. This is Dr. Boiko’s second mission to Rwanda.

About 50 years ago, for my first Brownie Scout meeting, I needed to bring 15 cents in dues.  My mother gave me a 50-cent piece. Not recognizing it as a valid coin, I cried and carried on so much that the Brownies wouldn’t let me in with counterfeit money, that my mother fished out a crumpled dollar bill that I brought proudly to the meeting.

Flash forward 50 years to San Francisco International Airport on my first leg of my weeklong journey to  a family medicine conference in Rwanda in 2010, where I was to speak on tropical dermatology. It’s 6 a.m. and I’m standing at the check-in counter and I realize I forgot my yellow shot record. Can’t leave to get one at Kaiser Permanente San Francisco. I called my husband in a panic; he calmly suggested printing it out from kp.org. No business centers open at that hour so paid $50 to use the Admiral’s Club and printed two copies.
Still, doubts plagued me. If it wasn’t on yellow paper and folded into a booklet, would it pass muster at Rwandan customs?

I shared my fears with the flight attendant. Maybe at the next stop, JFK in New York City, there would be a travel medicine clinic and I could get a more official-looking document. The pilot actually radioed ahead- sorry, no travel clinic at JFK.  No time to hop in a cab and find a doctor’s office.  So off I went to Brussels, then Rwanda, a niggling fear that I might be turned away at the airport keeping me from dozing.

Sixteen hours of airtime later, I approached the bored young customs officer in the dimly lit terminal. He glanced up at my face, stamped my passport and said “Welcome to Rwanda.” My Brownie fears melted away. He had not asked for my shot record.