Updates from Zambia

The below post was authored by John Heimerl, PL2, University of Minnesota Pediatrics Residency.

Greetings again from Zambia.

I succeeded in finding a better way to access the internet. There is an internet cafe a short walk from the TTF clinic and the speed is fast enough to upload pictures and not take all day to do it. This is a good thing, as TTF has been without internet all week.

Earlier this week while Dr. Tim was south at a conference, we had a traditional Zambian meal together at the farm.

Our meal consisted of nshima, Chinese cabbage stew and
sausages

Nshima is the traditional food here, and likely everyone in
the country can make it. It is made from ground corn and is the staple
of the local diet. Nmisha typically is served with beans or rice, and sometimes fish or chicken is served as a side. I can't
say there is much taste to it, but I kind of like it at the same time.
I will try to bring some back with me so I can make some for my
wife.

Preparing Nshima and the meal

Clinic has been busy this week. We have seen and enrolled
numerous children and adults. One of the children was 13 month old with
stage IV HIV, due to severe wasting. He will be starting ARV
therapy and has been enrolled in the TTF nutrition program.

One of my roles has been to help make it easier to track progress while children are getting nutrition support.

This mother and child were both new to the clinic. The boy is 4 years old and, as you can see, has a rather large umbilical hernia.

While Dr. TIm was away I did some shopping. I was able to find
a nice selection of tomatoes just outside of the clinic for a good
price

Till next time,

John

John Heimerl's 3rd Week In Zambia

This blog posting was authored by John Heimerl, M.D., 2nd year Pediatrics resident at the University of Minnesota.

We had another busy week at TTF.

Clinic days are full of patients to see. Here are two pictures from clinic.

Here is the TTF clinical team, along with a patient and his mother in the center.







Here I am with the pharmacist, Thomas.

I also had the chance to visit the large University Teaching Hospital
(UTH), which is the referral center for Zambia.

A nurse named Clements (the only male nurse I saw during my visit) give me a tour, which I limited to three hours. He showed me each section of the pediatric wards.

The pediatric department is spread out over a number of buildings, each housing a different ward.

I saw the emergency ward, then Admitting. From Admitting, patients are sent to one of the five remaining wards--Malnutrition, Heme/Onc, PICU, General Pediatrics (x2) and Endocrine.

I wasn't able to take any pictures of the inside of the hospital, but here is what the grounds and building look like.

Also last week I was able to do something I failed to do on my last trip to
Zambia--I took a bus 400km south to Victoria Falls, which borders
Zimbabwe (I hear we made good time; it only took us 6 hours, and I've heard it can take up to 10).

As you can see, the waterfalls were spectacular. In a couple of sections, you are drenched by the spray from the water falling, and it was entertaining to watch visitors get drenched.

Well, I have to get back to clinic to see the rest of the patients. Hope to send more pictures soon.

Cheers,
John

Dr. Heimerl in Lusaka, Zambia

_This entry was written by John Heimerl, second-year Pediatrics resident at University of Minnesota and member of the Pediatric Global Health Track._

Greetings from Tiny Tim and Friends and Lusaka, Zambia!

**Me spending pool time with the children at the farm**

TTF, the partner organization I'm working with here in Zambia, was founded with a mission to identify, test and initiate HIV treatment to local Zambian children, with the goal of stabilizing them on their treatment before transferring them to the government HIV treatment clinic.

In addition to the medical aspect of their care, TTF also provides a large social component, with Zambian social workers on site to provide counseling and education, as well as a place for them to live for a time if they are in need of extra care.

I am now into my second week here in Zambia. Since arrival I have remained busy.

On my first day I caught up on some much needed sleep, after the 26+ hours of travel from Minnesota. I also walked from the Tiny Tim and Friends (TTF) farm to a local village, Grieps.

The village is just a twenty minute walk from modern houses with electric and plumbing, but lacked even the most basic western "necessities".

Their water came from a central well. Water is collected in buckets, cooking is done on open fire pits, and an entire family occupies a small, one-room house.

I had the opportunity to visit the local school. The headmaster took me from classroom to classroom, and I got wonderful greetings from each class.

One class was learning of world geography, another their mathematics factors.

**Some of the village children of Lusaka**

February 7 was my first real day at the TTF clinic.

I started seeing patients right away, with one of the Zambian clinical officers (equivalent to a U.S. physician assistant).

The patients were all HIV positive and in clinic for one of several reasons. Some were due for their anti-retro viral medication (ARVs) refills, others had acute problems like pneumonia, flu-like symptoms or fevers.

The clinic has an on-site lab and pharmacy. Any patient requiring a higher level of care is referred to a local hospital for further management.

Over the past few years, TTF has worked on ways to better meet their mission, partnering with other organizations to find children and caregivers to enroll into the program.

One such organization is Grass Roots Soccer (GRS), which receives funding from the Elton John Foundation. GRS provides HIV eduction to children in the surrounding Zambian compounds (slums) and uses soccer as a way to engage the children.

At the end of the multi-week training, TTF hosts a graduation--a music- and activity-filled event--where additional HIV-testing for children also happens, with parental/guardian permission.

Last Saturday, Lusaka celebrated World Condom Day. TTF tested 165 children and adults at one of the compounds.

Multiple other organizations also were on hand to provide HIV testing and to provide education on HIV prevention.

**TTF group at World Condom Day (WCD)**

TTF has also begun renting a 40-acre farm, with hopes of growing local produce to be sold at markets. In time the income generated from the farm will be used to sustain the program.

**The farm at Tiny Tim and Friends**

A boy named Paul joined us here at the farm last week.

Paul has been on HIV treatment for some time, but was recurrently sick. Though his mother has noted that his appetite has improved since he started HIV treatment, Paul's family has not been able to afford to make more than one meal a day. So Paul came to live at the farm. He has adapted well to life here, and we are convinced after 5 days that his skin molluscum has begun to improve.

**Paul in the pool, you can notice the extent of his molluscum**

You can learn more about TTF here.
Till next time,
John Heimerl

**Tim, Winford and Paul at the farm**

Pictures and Reflections From Dr. Yablon In Bolivia

Blog entry, photos and captions are all by Dr. Brian Yablon, 4th year medicine-pediatrics resident at University of Minnesota, and participant in the Pediatric Global Health Track.

This is positive proof that I was in Santivañez!

I have just finished my second week in Chilimarca, Bolivia, doing a 2-month rotation through the University of Minnesota with support from a MAP International fellowship.

This international rotation is unique for our residency in several respects. First, the clinical piece is outpatient rather than inpatient. There is no hospital affiliated with this site.

Secondly, MAP Bolivia is a multifaceted organization with the aim of promoting total health. Health is looked at not as the absence of disease but as a culmination of positive factors in the environment, the culture, and the family.

There are several programs under the umbrella organization. I am working in Health Services, which is the clinic. The team includes a nurse, two nurse auxiliaries, a laboratory technician, a physician, and a dentist.

I have been seeing patients of all ages (the oldest so far being 94), but they have mainly been sending the pediatric patients my way. The consultations are actually pretty similar to what we see in the U.S.--respiratory viruses, gastroenteritis, pharyngitis, rashes, and ,of course, well child checks.

This weekend, I will accompany Teo, the clinic nurse, out into the community to do well child exams and vaccines. Next week, we will be doing health maintenance for all the children in the MAP school (about 160 children), which is done quarterly.

width="360" height="504" class="mt-image-none" style="" />




Teo, the clinic nurse, in the process of removing an infected toenail. I have much more graphic photos that I elected not to send.

A remarkable MAP program here is called Health Promoters, where people from the surrounding communities can come for intensive 5-week courses to become first level promoters, with additional complementary and follow-up courses offered later to become second- and third-level health promoters.

height="360" class="mt-image-none" style="" />




Here is one of the health promoters, Asunta (the woman in the hat). She is from remote Morichata, and she trained 18 years ago at MAP in Chilimarca. She has developed many projects in her community for health and wellness, education, and sustainable agriculture.






src="http://blog.lib.umn.edu/iac/electives/Yablon_MetWithHealthPromoter.jpg" width="504" height="360"

class="mt-image-none" style="" />




We met with a woman who had completed health promoter training 7 years ago. She explained that it gave her confidence, helped her establish equal footing with her husband, and enabled her to successfully manage several gardens and give first aid to people in her community.






src="http://blog.lib.umn.edu/iac/electives/Yablon_PromotersAuxilliaries.jpg" width="504" height="360"

class="mt-image-none" style="" />




Health promoters and auxiliaries meeting together.

The knowledge and skills that people develop in this program are impressive, and they bring back to their communities very practical ideas about how to implement water purification, organic family vegetable gardens, home building and maintenance to keep out the beetle that spreads Chagas disease, and waste management.

The upper level promoters also learn health care skills, from first aid to suturing to childbirth.

The program is predicated on participants thinking critically about themselves, their families, and their communities, analyzing the embedded power structures that act as barriers to achievement of health, and committing to making changes through consensus-building.

Last week, we went to visit the group of promoters, almost all teenagers, who just finished their first-level training. They were all positive about the experience and enthusiastic about making changes in their families and their community.

src="http://blog.lib.umn.edu/iac/electives/Yablon_TeenageCompleted.jpg" width="504" height="360"

class="mt-image-none" style="" />




These were the teenagers who completed level 1 health promoter training and were excitedly reuniting after the course. We drove 4 hours to their village of Santivañez.





src="http://blog.lib.umn.edu/iac/electives/Yablon_5NewPromoters.jpg" width="504" height="360"

class="mt-image-none" style="" />




Five of the new health promoters.

MAP also has a school, "Comunidad Educativa para la Vida," which has pre-kindergarten through 8th grade. Consistent with the rest of their philosophy, students do a lot of interactive games to teach each other while the teacher facilitates.

The students, starting from a very young age, also plant and tend the garden where they grow the food that is used in their lunches. Not only do they learn about agriculture, but they are also proud of what they have grown and consequently actually like to eat their vegetables.

width="504" height="360" class="mt-image-none" style="" />




Kids of all ages working in the school garden. They tend the soil, fertilize, weed, and perform manual pest control. They are very proud of the food they grow and they eat the veggies in school lunch.





width="504" height="360" class="mt-image-none" style="" />




This second graders is teaching us the importance of eating our fruits and vegetables.





height="360" class="mt-image-none" style="" />




Here is Claudia, the director of the MAP school, with her son.





height="360" class="mt-image-none" style="" />




This group of 3-year-olds at the preschool were extremely well behaved.





src="http://blog.lib.umn.edu/iac/electives/Yablon_KidsWithVisitor.jpg" width="504" height="360"

class="mt-image-none" style="" />




This is a photo of the kids with an American visitor named Deborah from MAP in Georgia and a Swedish volunteer named Maria.






width="504" height="360" class="mt-image-none" style="" />




Here is the lunch room with smiling kiddoes.





width="360" height="504" class="mt-image-none" style="" />




The fifth graders made maps of Bolivia--here's one of them!

Two other programs aim at integrating marginalized groups back into the community. One, called Learning About Differences, works with children with disabilities to develop their strengths and to facilitate an ethic where families and communities accept and embrace these young people.

The other, CUBE, is a center for children and adolescents who are victims of sexual violence.

They have a multidisciplinary team of psychologists, social workers and lawyers, and they have achieved good results in helping children cope with horrific violations and also in successfully prosecuting perpetrators, who (as in the U.S.) are most often members of the family.

width="504" height="360" class="mt-image-none" style="" />




MAP team meeting on Monday morning, 2/7. They always meet in a large circle and have a ¨horizontal¨ team structure.

I have been able to see and hear about all of the various programs so far, and I have participated in meetings with all the local MAP staff.

When not at work, I have gone one some beautiful hikes to waterfalls in the

mountains, as well as to explore the nearby city of Cochabamba.

src="http://blog.lib.umn.edu/iac/electives/Yablon_MountainInBackground.jpg" width="504" height="360"

class="mt-image-none" style="" />




This is a view of the bustling city of Cochabamba from the van, with mountain backdrop.





height="360" class="mt-image-none" style="" />




¨Micro¨ number 211 van that almost brought us halfway back from Pairumani before it ran out of gas. Good thing I wore my hiking boots.





width="504" height="360" class="mt-image-none" style="" />




This is the outside of our auspicious van. We also drove around with a dog and solved mysteries.





width="504" height="360" class="mt-image-none" style="" />




This is the inside of the van before it got a lot more crowded. The other pale people are American visitors from MAP International headquarters in Georgia. They were both auditing and helping to collect stories for fundraising for the program.

I also have informal gigs as a math and English tutor.

I am extremely grateful to the University of Minnesota for allowing me and other residents to do rotations in other countries in order to develop a valuable new perspective about health.

I am also very indebted to the staff of MAP Bolivia, who adopted me from the first day and who have made this such an amazing and inspiring experience so far.

src="http://blog.lib.umn.edu/iac/electives/Yablon_MotherDaughter.jpg" width="504" height="360"

class="mt-image-none" style="" />




Here are the mother and daughter who live upstairs from me. Their family took me out to dinner at an American-style fast food place my first Saturday in Bolivia.





src="http://blog.lib.umn.edu/iac/electives/Yablon_CafePairumaniPark.jpg" width="504" height="360"

class="mt-image-none" style="" />

Here's a cafe outside Pairumani park, where I went hiking on Sunday, Feb 6. The subsequent photos are all of the views in the park, which has mountainous terrain with a lot of eucalyptus trees and a fairly large waterfall. The views are of the whole Cochabamba valley.

height="504" class="mt-image-none" style="" />




This was our early dinner after the hike.





height="360" class="mt-image-none" style="" />




This is at a state park on the way to visit the newly trained health promoters. These structures are recreations of Inca-era corn storage silos, with ventilation to allow the wind to dry the corn and thatched roofs to protect from sun damage.







src="http://blog.lib.umn.edu/iac/electives/Yablon_Bolivia_map%20%289%29.jpg" width="504" height="360"

class="mt-image-none" style="" />





src="http://blog.lib.umn.edu/iac/electives/Yablon_Bolivia_map%20%2810%29.jpg" width="360" height="504"

class="mt-image-none" style="" />





src="http://blog.lib.umn.edu/iac/electives/Yablon_Bolivia_map%20%2811%29.jpg" width="504" height="360"

class="mt-image-none" style="" />





src="http://blog.lib.umn.edu/iac/electives/Yablon_Bolivia_map%20%2812%29.jpg" width="504" height="360"

class="mt-image-none" style="" />

For any resident with Spanish proficiency and an interest in community health, I highly recommend this rotation and would be happy to talk with you in more depth when I get back to Minnesota.

height="360" class="mt-image-none" style="" />




This is the view of the mountains over the MAP school (my neighborhood) at dusk.

Dr. Yablon Arrives in Bolivia

Say hello to Dr. Brian Yablon, who touched down in Bolivia this past week. Stay tuned for stories from the field.

Residents Abroad

Every year, the University of Minnesota's Pediatric Global Health Track sends about 12 residents abroad. Check this site for actual updates from their experiences.