John Heimerl Completes His Elective In Zambia

Wow, I am now down to my last few days in Zambia. It is amazing how fast time goes!

This past weekend the farm hosted a Tiny Tim and Friends social and graduation. Each month, children newly enrolled in the program gather to celebrate those who have been in the group already for six months.

The day is filled with education and activity and culminates with a graduation ceremony.

Over 80 children attended. I had the opportunity to take some good pictures during the event, and as soon as a camera was noticed I was surrounded by children asking to have their picture taken.

The farm also started building for the animal enclosures that are being planned for the farm.

This is the future site of the chicken house. The farm also plans to keep goats and ducks in the future.

Also on Saturday we visited Our Lady's Hospice.

Dr. Tim rounds there each week and sees the more complicated patients they are having difficulties with.

We saw three adult patients. One had suffered an acute intracranial hemorrhage following an eclamptic seizure, another was suffering from dementia, and the last was also suffering the devastating effects of a stroke. There were 28 patients at the hospice.

Our Lady's Hospice will be the site of the first pediatric palliative care center in Zambia.

TTF will start with 4 rooms at the hospice and then expand in time.

The project will allow for proper palliation and access to opioids when needed. Currently, terminally ill children in Zambia are either sent the University Teaching Hospital or are sent home with minimal pain relief.

The new palliative care center will be staffed with a specifically pediatric- trained nurse on site to care for the terminal children.

The training is intense and will take two months in Uganda.

There are big things on the horizon for TTF and the children of Zambia.

I will be traveling back to Minnesota on April 5, so this will conclude my blog updates from Zambia. Thanks to all of you for viewing my photos and posts while I've been here.

Cheers,
John

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

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**