Monthly Archives: September 2011

Susan Boiko, MD, Blogs From Bwiza: ‘90% of Life is Showing Up’

Monday September 19

As Woody Allen famously observed, “Ninety percent of life is showing up.”
For years Karl had been attempting to acquaint the Ministry of Health with his work.  Now he used a strategy that had brought him success in the past – just show up.
We assembled our team, in our nicest clothes, Karl in a dark blue suit and tie. We had a gift for the minister, who we knew was away, and hoped to present it to her administrative assistants, Herman or Kathy. In a cloth bag made at the Community of Potters Vocational School, we placed Karl’s and my business cards, and a CD of the Bwiza village singers. Outside of this was a cover letter requesting a meeting and a summary of the Health Development Initiative’s work.  All of this was placed in a manila envelope on which Claude wrote Kathy’s name in his fanciest calligraphy.

Although the main Ministry of Health is in a multi-story, modern blue and white building 2 doors away from HDI, the offices we were visiting were in a different building. We piled into a taxi for the short ride. No elevator, four stories up (I regaled them with the health messages painted in the Kaiser Permanente Zion hospital stairways) to one office where Kathy wasn’t in. Up another two flights to find that Herman wasn’t in but the worker accepted the package. Discouraged but not defeated, we made our way back to the HDI office to prepare for the major field trip (“study tour”) the next day.

Sunday  September  18
Festive decorations were hung- a plastic pennant banner with a soccer theme- I drew a poster of pin the trunk n the elephant and the elephant said “Happy 31st Birthday, Claude.”  A homeowner named Innocent  provided the party with a case of 24 assorted sodas, cold ( a rare treat).The foods were arranged on plates on the dining room table, pushed against the wall to make a buffet.  Karl arrived with authentic Italian pizza from restaurant Sol e Luna- wood-fired, with imported oregano, Italian pizza sauce, and provolone cheese. A taste of home! The guests arrived: Claude, the birthday boy, with a young woman in an elegantly tailored safari type dress who is a junior executive working on the opening of the first Marriott Hotel in Kigali this December. Dr. Dan’s family, his nephew, niece and cousin, all 13 and younger and excellent English speakers, arrived next. They were thrilled with the soccer-themed conical party hats and enjoyed wearing them.  One of Anna’s friends, Oswald, who is in the first MBA program just started in Rwanda, summed it up when he described pin the nose on the elephant as “ extremely amusing.” Everyone shrieked as the blindfolded contestants staggered about, pinning noses on doors, windows and even someone’s forehead!

The birthday song was sung several times, and additional gifts from Anna of a Rwandan storybook and  from me of a net bag to carry the presents and a Bryn Mawr Frisbee were presented along with the cherished soccer ball (Claude is a certified youth soccer coach and hopes to fields a team for under-12s in Bwiza).

Saturday September 17
Intermittent rains stopped the trip to the stadium. They did not, however, impair Jocelyn and I on a shopping odyssey in which over $300 US was spent with the able chauffeuring skills of “Taxi Rene” (this is his name in my cell phone).

We started from Innocent’s house, first stopping downtown at the upscale Simba market, where Jocelyn’s sister works in the bakery department. The size of a small US supermarket, it boasts many packaged products, a bakery and a café. Uniformed attendants patrol the aisles to help if you can’t find something. I was buying food and supplies for Claude’s 31st birthday party. I bought a gently used soccer ball for what it would have cost in the US new, paper plates, forks and napkins, candy bars and M&Ms, fruit to cut up, toothpicks and some croissants for breakfast the next day.

On to the East African Market a block away, a complex of shops within shops, storefronts built on odd slopes with irregular steps up, some at sidewalk level. Our mission here was to buy 60 yards of cloth for the marginalized Community of Potter’s vocational school in Rwamaganza, way to the east. The high school students practice sewing drawstring bags, self -tie bags and tote bags. Coffee Rwanda supplies the material and thread. The students supply the labor.  For each bag, labor is calculated which goes to the sewing program to buy more supplies. The teacher irons the bags with an iron which opens to reveal hot coals inside. The bags are then picked up by me before I leave Rwanda and brought back to the US, where they are sold on the Coffee Rwanda website.
Each piece of cloth is 48 inches wide and 6 yards long and costs $8 and $13. There are many lovely patterns, printed and cheaper than batik. My challenge is to find smaller patterns that would look good on bags. We buy a gigantic plastic zip top shopping bag to tote our purchases.

On to Madame Fatoush, an establishment where the madame herself, a woman of uncertain age attired in a sari-like garment lurks in a corner, occasionally crying out to her associates. We buy drawstrings for the bags.

Last stop is Nakumatt, a junior version of Sears. Many products you can’t get anywhere else are found here at a high price- a set of watercolor markers which would have been $4 at Staples was $20. We bought cocktail hotdogs and cheese to be cut up as hors d’oeuvres, a birthday cake that said “Happy Birthday Claude” and drinking water. The store not only sells food but household goods, furniture, appliances and agricultural tools. Kids were whining in the aisles for candy and soda.

Wednesday, September 14, 2011
Lots of excitement last night. We invited Field Officer Claude and Project Manager Josephine of COPHAD (Community of Potters Health and Development)  program, for dinner. They, and the houseboy-prepared dinner, were supposed to be at table at seven. At 7 p.m. the houseboy was nowhere to be seen. Dinner was cooking in the outdoor closet where the charcoal burner is kept but no houseboy was to be found. “Francois!” we called repeatedly into the night, but no one answered.  My sister Patricia, brother-in-law Karl, Anna and I had assembled in the living room when the power went out. For about 20 minutes we chatted by flashlight. Still no houseboy, no guests arriving.  Guests finally arrive at 8- still no houseboy. Karl and Claude start cooking the remainder of the meal.  I am chopping cabbage with Karl’s all-in-one survival tool. Meanwhile Claude cooks the beans with a pinch of Herbes de Provence that I brought along. Finally, dinner is served at 9:30 PM- just as the running water stops. I fall asleep at the table around 10:30 PM, just after the cooked cabbage is finally ready to be served. After I go to bed, Josephine volunteers that she has a friend, a married woman with two children in school all day, who could do the houseboy jobs for us: cooking, cleaning, marketing, washing and ironing clothes. They arrive this morning at 11:30 AM.  After each enjoys a refreshing glass of Rwandan milk, the negotiations begin. A motorcycle taxi from her home to the other side of the city is expensive- she wants $5 a day for transportation, plus $30 a day to be here from 6 AM to 4 PM (she will cook dinner in advance and leave it in the fridge) with Sundays off. Since her English is fluent and she is a secondary school graduate, this wage is in line with her level of education, but the usual unskilled  live in household worker would get $15 a month (remember, the per capita  income is $230 a year).
Hallelujah! The water comes back on! I spend the afternoon washing dishes, pots and pans for 6 people. Everything is scrubbed in cold water then repeatedly rinsed in boiled water from the electric teakettle. Since there are no shelves in the kitchen, the dishes are drying on trays balanced on dining chairs and the couch.
I pause for a moment- would my dermatology chief and the area medical director feel that I had wasted a day interviewing household staff and washing dishes? The answer comes to me in a flash when I recall Karl telling me about the traveler’s diarrhea he suffered at a previous visit. I am protecting my family’s health!
So what happened to the houseboy?  He reappeared this afternoon, as we walked out of the house on the way to a “resto” for dinner, because we won’t have a cook until tomorrow. He shook our hands with a wide, sheepish grin as we departed.

Thursday, September 15
Today was an important day in our work with 6 Community of Potters villages across Rwanda. Late in the morning, an important figure, a founder of COPORWA and Community of Potters vocational school headmaster in the southern area of Rwanda, Mr. Kalimba arrived at the HDI offices. A man who appears to be in his sixties, with a rotund figure and a snappy Pierre Cardin sports jacket (I know this because it is popular to leave the manufacturer’s labels on clothing), Mr Kalimba came from humble beginnings. Along with two other boys, he was the first in his forest-dwelling village to graduate from middle school. Representing indigenous peoples, he has twice spoken at the United Nations. Although he understands English, he prefers to speak rapidly in French, so that I strain to hear what he is saying. Karl’s French is more fluent than mine, so they discussed important  issues, namely

  •  Partners in Health has established a hospital and an outreach program to marginalized people, including housing and social networking, for 3 of the Community of Potters villages.
  •  Setting up a brickmaking industry in New Bwiza for the men. The army has lent diesel powered brick makers which make stronger, bigger bricks but diesel fuel is costly. The army will soon take away their loaned diesel machine. In new Bwiza there is a manual brickmaker that has interlocking bricks. Similar bricks are for sale for 500 RF each. Neighbors have been constantly inquiring about purchasing any leftover bricks.
  •  Starting a football (soccer) team in the village for 7-12 year old boys. Claude is a certified coach. They will need soccer balls and eventually, uniforms,(Shirts and shorts) socks  and shoes (can these be recycled from American teams?)

Mr Kalimba enjoyed the special lunch of maize (a dry textured mound of fine grits,) vegetable soup, and green bananas , with French fries as a special treat. As he was a visiting dignitary, a secretary was sent out to buy Fanta Citron (lemon soda).
The most inspiring part of the trip so far was going to new Bwiza, the settlement of 25 2-family homes and a community center under construction on a more gently sloping tract of land than the cliff hanging hillside of old Bwiza, which was previously used for growing plantains. High-tension electric lines are a 10 minute walk away so eventually electricity will be available in the village. Each home has a front door and back door, 2 rooms and barred windows with wooden shutters. The doors lock. The fronts of the houses will face a common road; the back doors will have outside kitchens with charcoal burning clay stoves and one pit latrine per family.
The houses have brick walls, high ceilings, and currently dirt floors. In one home the interior  walls had been smoothed with concrete.

The community center was impressive. The entryway sports 3 12 foot high square pillars faced with more costly orange-pink fired bricks set in mortar. There is a maybe 20 fort square meeting area and smaller offices. The roof is not on yet, but all the houses have corrugated metal roofs.

There will be community wells for water.

In the works- perhaps a nursery school and if they get the bricks a primary school, since the nearest one is a 45-minute walk one way up the mountain to Bwiza.
We left the community on foot and since it was a cool, pleasant late afternoon, walked down the road to where the paved road begins and we could pick up a bus, about a 45 minute stroll. Then another 90 minutes by bus, and 25 more minutes on foot, till we reached home. The distance was about 15 miles one way; by bus and motorcycle taxi from HDI, one hour. On foot, bus and foot again to our home in Kicukiro  took  2 ½ hours. We had a wonderful dinner left in the refrigerator by Jocelyn and shared it with Claude, Solange, who is a 23 year old college student being supported in her studies by Patricia and Karl (They pay 1000 US a year for books, tuition and some living expenses and Solange has to show her report card) and her brother. The hit of the evening was reading out loud the children’s book, Joseph had a little overcoat by Simms Taback. She laboriously read the English words and we all had fun looking at the pictures and explaining the meaning of the story. She proudly took the book home with her to read aloud to her younger siblings.
Change in plans: Claude does not want to go swimming at La Pri hotel tomorrow because he is ashamed of his flabby belly (which actually looks normal to me). So there is some kind of music festival featuring an American rock group with a Rwandan member at the stadium tomorrow afternoon at 4 PM. Will we go? Uncertain at this moment.

Susan Boiko, MD

Susan Boiko, MD: Getting Around Kigali by Car, Freestyle Bus, Motorbike, On Foot…

Today I took every mode of transportation available in Kigali except for airplane or boat.

I started with a ride in Dr Joseph’s car. He is one of the Health Development Initiative  directors, to the HDI offices.  From dirt to cobblestones to paved asphalt, we even passed numerous traffic lights (there was only one in Kigali last year at this time).  Next I went with Claude, the factotum for the Pygmy Survival Alliance,  known as the Peoples Survival Alliance, on foot for about six blocks to a freestyle bus. it is a minivan holding 14 passengers. It has no label showing a route, so you ask when it is at the stop; you get on, knock on the roof when you see where you want to get off, Pay 60 cents as you exit. Next, another walk to the house we’ll be renting when my brother-in-law,  Dr. Karl, sister Dr Patricia, and adult niece Anna all join me on Saturday for 13 days of hard work visiting with the comunity members in Bwiza and traveling to another village co-sponsored by Partners in Health.

But I digress.

After walking back to the town center of Kicukiru, we had lunch at Chez Lando, got picked up in an SUV by a friend if Claude’s who just happened to see us walking along the road, then I got on a “moto”, motorbike taxi where the driver gave me a helmet as I wrapped my arms around him and held on tight for a gentle downhill ride to the HDI office, where I helped one of the office staff, a recent high school graduate who hopes to attend college in the United States, look for information about the SAT exam being given in Rwanda.  Finally, my ride home was with Dr Joseph’s wife Betty in her car, stopping at a market to pick up some diapers. Next to the market was a Fench bakery, so brioche for breakfast tomorrow!

Susan Boiko, MD
Kaiser Permanente San Marcos (Calif.) Outpatient Medical Center

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