Sunday, July 31, 2011

Sunday, July 31, 2011

It has been a busy month for the two of us! July creeped up on us quickly and there's been no shortage of things to do. Brooke's house became a mini-lab, full of lab equipment and Alex's house became a mini-print shop, full of paperwork and binders to be organized. One of the major things that we've learned about international projects from this experience is that sometimes you just have to play it by ear. Both of us prefer to be very organized and precise about having things completed and ready to go but this isn't something that we've been able to accomplish so far. Trying to coordinate with the Ministry of Health and doctors and nurses on Christmas Island only through email has been a challenge that has been further complicated by the cultural barriers between us. For example, during the IRB approval process, the IRB asked us what the Kiribati government's policy was on getting consent, does it need to be written or can it be verbal? When we relayed this question to our contacts on the island we were informed that this is a question that had never been asked before, there was no policy! So while they are trying to determine what their policy should be, our IRB approval is on hold. But despite all the craziness, we're excited to get on the ground in 2 days and start working with our team on the island. It's amazing to think that we're doing something that's never been done before!

Here's just a look at the huge amount of stuff we're taking with us!

Wednesday, July 27, 2011

Penultimate Week Update

I've lost count of how many weeks its been. I think 4. But I know that it's my second last week, hence the title.

Last week I was in Durban, on the east coast of South Africa. Unfortunately, two of my meetings fell through, so I had a relatively quiet week. I met with the Department of Health as well as one of the largest Non-Profit Hospitals in the country (McCord Hospital,

My trip to McCord was fantastic. Not only was it incredibly helpful to my research, but it was a place that I could see myself working one day after I get my training as a doctor. McCord allowed me to open up an entire new category of public-private collaboration in South Africa, the area of Provincially/State Aided Hospitals and Clinics through the country. These are Non-Profit Organizations that provide services just like a regular hospital or clinic, but get a portion of their funding from the government. They use the excess funds to develop the hospitals infrastructure and slash prices to make their care more affordable. It's a brilliant solution that only non-profit organizations can survive on.

This week, I'm in Pretoria, the administrative capital of South Africa. I've already met with someone from the National Department of Health, have set up an appointment with the National Treasury (they have an official PPP unit for funding projects), and am in communication with the National DoH PPP director. Unfortunately he is out of his office this week and will not be able to meet. I'm heading down to Jo-burg this afternoon to stop by a research institute and then I'll make a few personal visits before I head back.

I've spent the past week trying to understand the structure of the health care system here in South Africa and doing so has helped me understand the different categories of PPPs. One of my preliminary conclusions is that I've found three major types of public-private collaboration in South Africa, (1) official Treasury-sanctioned public-private partnerships, (2) funding of/collaboration with non-profit organizations, (3) contracting out of services to private health professionals. There are multiple theoretical systems with which to classify the different models for PPIs. One was even developed specifically for South Africa, however I've found that one of the systems developed at UCSF seems to be the most useful for both categorizing and then for going backwards and trying to get information on a project simply by looking at the model category.

I head down to Cape Town at the end of my trip to hopefully meet with someone from the Department of Health, and I'm hoping to get a meeting with the President of the South African Medical Association as well. We'll see how those stack up-but I'd be quite fortunate to get either!

Tuesday, July 26, 2011

July 26th, 2011

We have met with all four schools that we will be working with to conduct research assessing girls' knowledge about physical fitness. In the two high SES schools, Seeta and St. Lawrence, the girls are open to sharing their thoughts and have a wide knowledge about health in general. They are relatively up to date on new findings in health (for example, the health benefits of red wine). Although they are hesitant to take on sports as a hobby, they were eager to learn yoga with me, and were pleasantly (hopefully) surprised by how tough it is to stand still. Because they come from families who can already afford their expensive education and their well-rounded education will most likely land them a good job, these are the girls that will have to battle overweight in the future. However, with encouragement their habits can be changed. They already look up to western celebrities such as Rihanna and Beyonce, they just need that extra push to also take up exercise habits.

The two low SES schools are a bigger challenge. The girls are reserved, quiet and painfully shy. In their traditional village culture, women are supposed to be reserved and do as they are told, so it is hard for them to open up with their own thoughts, especially to a foreigner. The answers that they were giving seemed to be "textbook answers." When asked about the importance of exercise, they said "to prevent high blood pressure," but none of them had any idea what high blood pressure means. After a few sessions, they have begun to open up and answer and ask questions more freely. We allow them to submit questions on paper if they are scared to raise their hands and ask. What seems to be the most immediate concern, however, is not physical fitness, but it is information about sexual health and safe sex. Even though their culture values virginity, many of the girls are having sex, but are not given the information about how to have safe sex. They are curious, and because it early sex is shameful in the community, they are too afraid to ask anyone but their friends about it. I want to share everything I know but I must wait until there is a curriculum that I can follow, to give them information that is culturally-appropriate and approved by the community.

Yesterday at Bulamu SEED, a government school for low SES high schoolers, we played a game where everyone sits in a circle called "I love my fellow girls who... (insert something about yourself that other people also share)" for example, "I love my fellow girls who have a brother." Then, everyone who has a brother must stand up and run to an open seat. They really loved this game and were laughing and being silly. I was excited to see them giggling and having fun, and we've made a lot of headway in getting the girls to share their personal opinions and questions.

Today, I will be visiting a health clinic in the village.

Till next time!

Monday, July 25, 2011

Stephanie's Gift

Life in the Tanzanian village is hard. While it's not the kwashiorkor picture of poverty I had expected, people do work hard to get by. As a foreigner, you start to become desensitized to the poverty after a couple weeks, but once in a while, you come across a story that really tugs at your heartstrings...

I met a boy in the village today who became paraplegic shortly after the death of his mother (the reason for his paralysis is unknown). Hi father had left them long before, so he is now under the care of his aunt and uncle. They have cared for his basic necessities, but they do not have the resources to support his disability. As a result, he spends the day crawling around his house. His knees have become so rough from the crawling that you can't even straighten his legs for him. The one thing that the boy desires more than anything else is to go to school, but he does not go for shame of having to crawl the distance to school.

A couple of weeks ago, Stephanie (one of the guests at the hostel) found the boy and was moved buy a wheelchair for the boy. Because the wheelchair had to be delivered from another city, she left before she could give it to him, so my friends and I had the privilege to bring it to him. The smile on boy when he saw his new wheelchair was priceless. He was so excited to try it out for the first time, and all he could talk about was that he would be able to start school the following day.

Economics in Tanzania

One day as we were riding back home from our interviews, we were met by a massive raincloud. Raindrops came pelting down on us as we found shelter at a nearby coke stand. While we waited out the rain, I had a very productive conversation with Killion, our translator. Interested in how financial prosperity affects a family's willingness to seek medical treatment, I asked Killion to explain how the local village economics work, but instead, I was given a brief history lesson on the economics and politics of East Africa. This is what Killion told me...

When East African countries gained their independence, they had one of two options: completely abolish their colonial political and economic structures and create a new country from the ground up or build upon the existing system and make gradual improvements. Kenya, a country that chose the latter, has thrived economically in comparison because it built its industries on top of the existing framework. Tanzania, on the other hand, is far more impoverished because it demolished not only the framework but also the infrastructure that colonialism left behind. The Tanzanian government didn't have the immediate resources to build a successful country from scratch, and widespread political corruption compounded the problem. As a result, Tanzania has become one of the poorest countries in East Africa despite its wildlife and mineral wealth. Some villages watch their agricultural surpluses go to waste while others starve because of the lack of roads connecting the country. Furthermore, the value of the Tanzanian currency has dropped below the Kenyan shilling in the past thirty years as a result of poor global monetary policy, affecting the buying power of basic commodities.

Killion's lesson ended here because the rain had passed and we needed to get back on the road. That was probably one of the best conversations I had with Killion. I wish I knew more about the regional history and the economics of developing countries to learn more from him, but alas, maybe the next rain.

A Wedding and A Funeral

In our time at Shirati, I was invited to a wedding and a funeral, and they surprisingly shared many similarities. I was a bit disappointed with the wedding because I had imagined a traditional African ceremony, but instead, it was very much of a Western-style reception. The decor, format, and speeches followed similarly to that of a reception back in the States. The one unique thing was the procession of gifts. Guests floridly present their gifts because the culture says that the more you embellish on the opulence of the gift, the more you cherish the couple.

The funeral a week later was remarkably similar to the wedding reception in that it was more of a celebration than a somber event. Speeches were made and the achievements of the deceased were highlighted as the feast and bright conversation presided over the guests. Interestingly, funerals draw crowds of hundreds, even a thousand clan members, and can last for as long as a month of celebration, whereas weddings had much smaller audiences.

Sunday, July 17, 2011

Picture Update!

Sunday July 17th

Had a whirlwind of a few days! I spent last Friday at the Larawatu Malnutrition Clinic again. Rainy (my translator) was sick, so Dr. David (the SF doctor) took her place. After passing out eggs and weighing the children, Dr. David and I searched the village people for eye cataracts. Cataract surgeons from Australia are coming in two weeks to perform about 100 surgeries. They only perform surgeries on mature cataracts and only on one eye of each of the patients. This way they can double the number of people who receive this surgery. We stumbled upon a very sad case. I noticed a small baby with reflective eyes-- the opposite of cross-eyed. Beyond that, the baby looked pretty unhealthy and was struggling to keep his head up. I called Dr. David over and he had seen this baby before for skin problems. He thought the baby may have TB which is becoming a big issue in the villages because it is contagious. After discussing the baby's situation with the 20-year-old mother, Dr. David learned that 1. the baby was 1.5 years old but looked like 6 months, 2. he cannot walk, talk, etc 3. his 22 year-old father was a drug abuser in Bali and contracted HIV. This was just heart-wrenching; staring at little baby who was so unhappy, fussy, no appetite. The mom was doing the best she could to keep him calm. This probably means the mother along with the baby both have HIV. I was in awe trying to take in this bad news. I know SF does not (yet) provide support to HIV cases. Although the government does have HIV drugs, I know that they are expensive and must be rotated often. The bottom line is that this case probably will not have a happy ending. I was just looking at the father as Dr. David put on his gloves and felt around his lymph nodes, thinking wow he is my age. The father had a very hoarse quiet voice and was skinny enough to be on the malnutrition program himself. The mom remained very calm. She obviously knew something was wrong with the baby, but I'm not sure she knows the extent of his issues. Interesting to observe the way Dr. David is so patient and gentle with his patients even as kids, grandparents and headmasters of the village rush to the scene. The village is much different from the sterile hospital room secluded from other patients. Rather, everyone in the village is taking note of the issue and listening in with eyes wide open. Probably a good thing after all as HIV can spread easily through Larawatu with sword fights, sacrifices and sexual encounters.

I woke up early Saturday morning to watch the baby turtles hatch and struggle to reach the water. It is amazing that they know exactly which way to go, minus one or two stragglers. We are not allowed to interfere in the process because it is natural and Nihiwatu wants the turtles to sense the smells and atmosphere of the beach. This way the turtles will come back to this beach and hatch more eggs. The turtles are just tiny--a few inches wide! It is actually quite hard to watch them hit the water because waves are pounding, white water is crashing. The turtles get washed up and smashed back into the water. Only a few make it because of predators. I spent Saturday running an eyeglass clinic in Rua village. We saw about 35 patients, all older. We have an Indonesian eye chart for far-sightedness. I learned the Indonesian words for the pictures on the charts so I can point to the picture and ask if they can see it. I really enjoyed working this clinic. I definitely needed Dr. David to translate a few times when patients had different problems--cataracts, one eye was worse than the other, or when they wanted to walk out of the clinic with their eyeglasses on instead of using them for reading only! One lady was quite funny. She was my first patient and stuck around to observe other people being tested. She watched which glasses they received. She looked a little unhappy and jealous almost! A few hours later, the lady came back with her bible (tiniest print) and said she couldn't read it which really bothered her. We then adjusted the prescription and she could read the bible! She was ecstatic. All of the Sumbanese patients came in their best-dressed clothes. The ladies wore lacy colorful tops, with stitched skirts, and hair in buns. They dress up when they go to the clinic. They were such sweet and gentle elderly people.

Yesterday afternoon Nihiwatu put on a traditional horse race on the beach! It was fabulous. We all had to be creative in making hats--many were banana leafs, floral headdresses and woven crowns. The horseriders are wild! None of them wear saddles. It looks like a nightmare trying to control untrained horses!! It was a lot of fun.

Dato took me to meet Margarita and her family in her village this morning. They were all smiles! They immediately laid down a woven bamboo mat for me to sit on. They brought out coconut juice, hot chocolate and peanuts on a big tray. We sat in a circle and I asked Margarita and her family many questions. Unfortunately, she does not speak English and I do not speak Indonesian. Dato told me it's easy and I must start. So that is my next goal! Maybe I will learn a few basic conversation topics so I can now call Margarita. Margarita, by the way, has a cellphone and facebook. This was all so bizarre to me. Here Margarita is living in a bamboo village with large funeral rocks, water buffalo, and no electricity. The irony is so interesting. Dato kept calling Margarita "the boss" because she is so educated now and living a good lifestyle. She supports her parents and makes good money working for the government hospital. I am so proud of her. It also humbled me to see how her life has changed for the better. It makes me feel very satisfied thinking that I paid for her nursing education and her life is forever changed. Her mom made me a woven ikat embroidered with my name. It is bright blue, green with a Sumbanese pattern. The Ikats are dyed with local plants and minerals. Ikats are worn around the waist or like a scarf. Ikats take a long time to weave and so many Sumbanese believe they have magical powers and strong symbolism.

Wednesday, July 13, 2011

Monday, July 11th

Monday, July 11th

I spent yesterday afternoon with Dato, a Sumbanese man who has worked for Nihiwatu since it has opened. Dato is like the mayor of the West side of Sumba. He owns the reef on the Nihiwatu shore. Dato took me to his beautiful village where the children are healthy, clean and happy. There was a significant difference in Dato's village where the SF has helped them for several years. I even found a young teenage girl wearing an Irvine Laser's Soccer jersey, which is the team I played for in 7th and 8th grade! What are the chances!!! Dato was proud to take a picture in front of the bright yellow SF water tank sporting his usual Sumbanese warrior attire. I have forgotten to mention that all the Sumbanese men carry "Sumbanese guns" (machetes) around their waist 24/7. I've become so accustomed to this that I forgot to mention it! The swords are used for all sorts of daily activities--slicing coconut, opening up betel nut, chopping trees, and slicing the neck of animals during sacrifices. During all funerals, the Sumbanese sacrifice their animals--water buffalos, pigs, goats--which are all very sacred to them. Imelda (SF staff) was telling me Rudy's (SF staff) grandfather passed away and the Sumbanese sacrificed 14 water buffalos at his funeral. The more animals signifies his importance in the district. Rudy's grandpa was a leader who fought for and won the land in the valley which is luscious and green. Today was an ominous day: we drove 3 hours to a village and saw about 3 funerals which buffalo lying dead on the ground. It was quite a scene. The families then take home buffalo to eat. Just so you are aware, the water buffalo are the most sacred and important animals on the island. They can cost up to 65 million Rupiah. They are often given as dowry to the wife's family when a man wants to marry a woman. However, I have met many Sumbanese who do not like this tradition because a) they are almost buying women b) the water buffalos are worth the most money. The animals are a Sumbanese's bank account. Dato and I then went to Wagoli village which is atop a mountain. Gorgeous view! The famous Sumba Foundation symbol rock is there. The men there also showed us the headstick pole. The Sumbanese men used to be head hunters and would post the skulls on the pole. Insane culture and tradition. At Wagoli, we went into a hut where a 55-year-old woman lay moaning by the fire. She looked like a pregnant 80-year-old. It was awful. Her feet and ankles were swollen, her stomach as big as a balloon, and her frail arms and legs lying there. This woman hasn't moved for two weeks because it would be impossible to get her to the hospital or SF clinic. I am going to bring Dr. David (SF doctor) to Wagoli, hopefully tomorrow. She was thankful for us.

Today was overwhelming. 6 of us journeyed over to the Kodi District which is about 3 hours away from Nihiwatu. On the way, I met Celestiana; a young girl who was saved by the SF last year. She was bone-thin, hours from death after contracting cerebral malaria. Celestiana couldn't have been cuter--she immediately jumped on me and I carried her around for 15 minutes. Although she can't talk much, Celestiana was happy and playful. Yalawatu village in Kodi was very hard to see. Sumba Foundation doesn't help Yalawatu because it is too far. The village has nothing--no water, harvest has failed for two years now, no income, the kids don't visit the doctor when sick (too far) and they only eat cassava. They eat once a day at lunchtime and not before or else they will go hungry the rest of the day. There are 20 people in one house. Compared to the villages I have already interviewed, Yalawatu is in the worst shape. It was so tough because we spent yesterday looking into the village, researching their lifestyle and surveying them. However, we did not bring anything to help them. Hopefully in the future, SF can put a system in place where one person from Yalawatu can come to West Sumba every month to pick up milk powder and other foods. We also met a young 20-year-old man who looked like he was 5. He got cerebral malaria when he was 5 and wasn't treated soon enough. His growth is completely stunted and mentally, he is not there. Rainy told me that Kodi only receives money every 6 months from the government whereas the villages in West Sumba receive money every 3 months. There is definitely a large separation between rich and poor. The system makes no sense. Apparently, the district leader of Kodi is not as forward or forceful when asking for welfare from the government. As a result, the Kodi villages suffer. There is a ton of land near the river where Kodi gets its water and I asked Rainy why the villages don't move there. I guess the land is owned by someone else.

It has definitely been hard to research in a perfectly scientific manner. It is difficult to know whether I survey all of the moms or some are gone during the day--farming, getting water, etc. It is also tough to make sure every mother understands the questions thoroughly. It seems like some copy what their friends say when they don't know how to answer.

We stopped for a picnic on Perro beach (perfectly untouched and beautiful) on the way home.

Yesterday during malnutrition clinic at Deke, the government was there also. As soon as the government found out SF started the malnutrition program, so did the government. We pass out 7 eggs per week and the government passes out 1 egg per month! I can't even believe that! That is so pointless and definitely will not reduce the malnutrition rates.

Thanks for reading,


Tuesday, July 12, 2011


I’ve been slowly learning Lugandan, the local language they speak here. My jaw’s sore from trying so hard to form the words of a different language. However, “Olyotya!” is one that I have down. It means “How are you doing?” and is a greeting you say to someone when you approach them.

A little bit about what I’m doing with Twezimbe. We’ve isolated 6 schools, 2 of high socioeconomic status (SES) and 4 of low SES. The four low-SES schools are each from different sub-counties of Uganda. The idea is to get together a group of 20 girls ages 11 to 21, broken up into a younger group and an older group, to provide a safe place for them to talk about girl problems. Most girls even in our own country don’t like to open up about their awkward encounters with boys, problems with periods, and disproportioned body parts. Hopefully through these small groups we can facilitate a discussion about these problems, with an emphasis on physical fitness, obesity, and diet. St. Lawrence, one of the high SES schools, is completely on board. Their PE teacher has had trouble getting the girls to participate in gym class, so I proposed dedicating a session for yoga and pilates, something they’ve never heard of before.

We’ve also spoken to two schools of low SES, and I’ve had a few more problems with those. The headmistress of St. Mark didn’t understand what exactly was the benefit of our program, and the headmistress of Bulamu questioned whether our time spent would be effective. Both of those are valid points. Indeed, it’s hard to understand why physical fitness and non-communicable diseases even matter when you’re still struggling to scrape by with just enough food to eat. Yes, it’s an up-and-coming problem for the world’s low-income countries, but I only know that from days of reading articles and looking at statistics. The locals have more dire issues to worry about. But I suppose our presence there is to assess their knowledge and thoughts about these issues, not necessarily to solve a problem.

Today, we visited the Twezimbe office that is in charge of Mudwma sub-county where Bulamu school is located. They were having a sub-committee meeting, where the representatives from all the villages in that sub-county meet and discuss issues. It was inspiring to see the young people that lead Twezimbe speak so passionately (in Lugandan of course) and the village leaders listen so intently, under the shade of a tattered blue tarp supported by tree branches. Yet, an air of professionalism was expressed in the straight rows of chairs lined up one after the other, and the notepads and pens in the hands of many of the sub-committee members. Suddenly the speakers started pointing at me, and the next thing I know I was to “say a few words” to the group. I had nothing prepared and those that have had me in class know that I am not the best presenter. Of course to make matters worse, not a minute into my introduction everyone started laughing. They couldn’t understand the English I was speaking and needed a translator. Through exaggerated hand motions (my nervous habit during presentations), I spoke for about five minutes about our project and the importance of awareness of non-communicable diseases in the next few decades for Ugandans so that it does not end up with the monetary burden that the US has had with diabetes, heart disease, and the like. I saw a few heads nod. I’m not sure if the rest of the group bought my speech but I gained confidence as my speaking picked up momentum. I’m proud of how it went!

The site of the Twezimbe office was also the place where girls were put through a 9-month training program to learn the skills necessary to make clothes of quality high enough to be competitive in the market. At the end of the program, each receive a sewing machine to take home.

Till next time!

Monday, July 11, 2011

Arrival in Kampala

Descending into Entebbe, Uganda, the landscape was worlds different from Dubai, where I had a layover last night. While Dubai sprung from a desert with sparse shrubs, Uganda is lush with vegetation. Green grass, thick trees, grazing cows, and red dirt set the background for the view form the car on the hour-long ride from Entebbe to Kampala.

This is my first time out of the country alone, and I feel like a little kid in a candy shop, so eager to take in everything and do as much with my time as I can. I am here to work with the Twezimbe Development Foundation started by former personal private secretary to the President of Uganda. From what I hear she’s a powerful political figure and popular among Ugandans. I am staying in her house in Kampala, the capital of Uganda, and I feel very fortunate to be able to.

Driving around Kampala, I noticed that the city was actually a lot like some parts of China. Commercialization hasn’t really taken over and business consists of mom and pop shops selling their wares along the sidewalk, every shop window is small and right next to the next one. Fruit stands are often homemade and the many of the homes look like they were built by the families themselves. I noticed that a lot of them were carrying large yellow jugs. Shida, my Twezimbe helper, told me that 60-70% of families that live in Kampala don’t have running water so that have to fetch water in these yellow jugs, called Jerry cans from the water spout. Children and adults alike were carrying these around everywhere we passed.

Today I will be going to Twezimbe for my first day of work. Twezimbe Development Foundation was started by Madame Amelia after she stepped down from her position as secretary to the Pres. Madame petitions for monetary support from the government for certain projects that Twezimbe carries out. Their projects complement all parts of life, with a focus on rural villages. For educational support, Twezimbe builds and restores schools, and provides lunches and books for the kids. For agriculture, they distribute seedlings and give farmers technical support. They also give a cow to each farmer, then when the cow has a calf the farmer is to give the calf to another member of the community, in a program called “Give a Cow.” For economic support, they have taught women how to make crafts so that they can sell them in the markets. A lot of the young folk from the villages leave to go to the city, leaving the villages full of the elderly, which is a big problem. Also in the villages is the problem of domestic violence. While the culture in the cities has revolutionized so that women are seen more as equals with men, the villages have not caught on and women are not aware of their rights. I will be working with 4 schools, 2 of high SES and 2 of low SES, and talking to girls about body weight, body image, physical fitness, and obesity. More on that later when I make a plan of action at work today.

Our Burkitt's Patient

Although the vast majority of Burkitt’s lymphoma patients are found in the Malaria belt around equatorial Africa, it is still a relatively uncommon illness, especially when compared to HIV or Schistosomiasis. The number of patients in a small region such as Shirati varies greatly, and it just so happens that there was one Burkitt’s patient when we arrived. When we asked about his history, we found that he had not responded to treatment as had hoped (with typical cases, the tumor almost disappears after the first dose of chemo). He was diagnosed just a few weeks before we arrived, and he had already undergone four doses. The tumor shrank a little with the first dose, remained stagnant for the next two, but had started growing again last week. His demeanor reflected his history. When we went to visit him and interview the mother, the 8-year-old boy was drained. He seemed to be in pain with each movement and had to lie down with each exertion. There was little more the Shirati clinic could do for him since he was not responding to the chemo and was referred to the regional cancer center in Mwanza.

Getting the boy to Bugando is almost another story. It is amazing how differently some people can react when given similar circumstances. In our interviews, we’ve talked to parents who went to great lengths and sold half their fortunes to bring their child to treatment facilities across the country when treatment at Shirati wasn’t working. This boy’s father, however, had spent his money paying the dowry for another wife. When confronted with the need to send his son to Mwanza four hours away, he lied about how he could catch a ride with a friend. It seemed clear that his only intentions for the boy were to take him home and wait for the cancer to take its course. Unable to accept such inhumanity, Dr. Kawira insisted he contribute any amount. My friends and I were happy to donate the entire cost, but we wanted the father to take some responsibility. Grudgingly, the father offered a small sum.

With this ugly episode behind, Dr. Kawira arranged for the boy and his mother to be taken to the hospital at Mwanza and start treatment. He arrived last Wednesday and was given IVs to rehydrate and prepare him for the taxing chemo. Unfortunately, we got word on Saturday that he passed away that morning right before his treatment was scheduled to start. Dr. Kawira assured us that we did everything we could to help, but the question still looms: would he have survived if he had gotten to Mwanza sooner?

Saturday, July 9, 2011

Friday July 8th

Today, we went to the Larawatu malnutrition clinic which has been running for three months now. We weighed the babies and passed out eggs and milk for the week. The kids then eat porridge while we are there so we make sure they are eating at least once a day. I asked Rainy how does SF monitor whether the families are feeding the kids with the food we provide. Usually, they can tell by the kids' weights weekly--if they are gaining, they are most likely eating. However, some families have been selling the eggs and milk and buying rice instead because it is cheaper. It is pretty upsetting that parents do not understand that their children need this protein for the week. Maybe the SF Malnutrition program should add an education component to it. Also, I find it interesting that during the surveys, many mothers say their children are not malnourished when in fact they usually are.

I ended the day with a run on the beach. The sunsets here are incredible!

Thanks for reading,


Thursday, July 7, 2011

Thursday, July 7th

Hey All,

I continued surveying yesterday and today. I have collected data on about 50 mothers & children so far. Interesting that some mothers don't even know their ages! Many of the kids' birthdays are written on their bamboo house. Yesterday, Rainy and I walked to Taailelu's water source which is 3 kilometers away and not an easy hike. The water comes from the ground. It is dirty and muddy. Most times the village boils the water to clean it. Sometimes, though, kids drink water straight from the source. No wonder why most children I have interviewed have had diarrhea multiple times. Taailelu has a big farming plot to harvest vegetables. However, the Taailelu villagers sell all of their vegetables for income instead of eating them. They use the money to buy rice because it is cheap (most farmers make $70/year).

I spent this afternoon inserting the data into an excel sheet. I compared the anthropometric data to a WHO growth chart. Most of the children are under the 5th percentile for all measurements--weight/height for age and weight for height. Pretty heavy to comprehend. Actually looking at the numbers makes the prevalent malnutrition seem more real. When I am in the villages observing, most children are smiling/happy and do not have the typical physical symptoms of malnutrition that I expected to see (rib cage sticking out, big stomach and small limbs).

Malnutrition clinic tomorrow.

Thanks for reading,


Tuesday, July 5, 2011

Tuesday, July 5th

Another awesome day. I met Rainy at 9:30 to head out to Deke village which is about a 45 minute BUMPY drive. The malnutrition program at Deke started three months ago. We were greeted with "salamat pagi" (good morning) from all the kids. We spent the first half of our day recording weights and passing out eggs, vitamins and milk for the week. All the mothers are holding their malnourished child or children and wait to be called. Rainy and I sit on a woven bamboo mat in one of the huts. It is pretty chaotic: there was a horse under the hut eating right behind us, pigs and dogs getting into fights, kids crying from being weighed and mosquitoes all around us.

After the typical malnutrition program and food distribution, we started the surveying. It was definitely harder than I thought. First of all, none of the women are literate, so they cannot write on the translated questionnaires. I imagined handing out surveys and pens to the mothers. But, now I know most women have only gone through elementary school (if they are lucky). Secondly, the survey went through three translations--Rainy asked the questions in Indonesian, one of the women from the village translated the questions to the Sumbanese dialect specific to the village, and Rainy translated back to me in English. I recorded all the information. There was definitely a lot of help from the sidelines--many women participating in the translation or explanation of the question. And a few laughs! One lady didn't consider herself to be married because it wasn't in a church. The surveying took quite a bit longer than I had anticipated. We will finish Deke village next week. After surveying, I measured the children's head circumference and height. Using these measurements and weight, I can look at the WHO Standard Growth Curve (and BMI) to see which children are malnourished.

We left Deke in the afternoon after a successful day. I spent the late afternoon surfing with the other kids my age who are also staying at Nihiwatu. It was epic!

Tomorrow we are going to an old village who has not received any Sumba Foundation help. It will be interesting to compare this village and Deke.

Thanks for reading,


Monday, July 4, 2011

Monday July 4th

Happy 4th of July!

I had an amazing day in Sumba. I woke up at 5:15 AM to go stand-up paddle boarding down the river. The paddle ended at the beach. Along the way, we saw many traditional Sumbanese villages. Women were washing clothes, 8-year-old boys were washing their horses and men were harvesting rice patties near the water. We saw lizards the size of my arm. We paddled through rapids and fell off a few times. We watched the sun rise and swam under palm trees that had broken off the bank. A very peaceful trip all around!

I was dropped off at the Sumba Foundation office on the way home to meet up with Rainy. Rainy and I developed more survey questions focusing on the mothers--education level, marrying age, etc. Then we left on a 26 kilometer rocky road trip to the local town, Wakabubak. I was really impressed with the amenities in the town. It was filled with stores imported from China. There were soccer fields, two hospitals, many churches, a police station, courthouse, bank and classic Indonesian food restaurants.

We stopped by the government hospital for which Margarita works. I was so happy to finally see her again after 5 years. We gave each other a huge hug and talked through Rainy who translated for us. She was dressed in a classical white nurse uniform triaging patients. Margarita said she couldn't be happier. She loves nursing, she helps pay for her parents and she still lives in her village. Margarita left the SF clinics for the bigger government hospital because she is a "VIP nurse." Not sure what that is, but it sounds good to me. Margarita now has a secure job and is still working for her people. She works at the SF clinics in the morning if she has night shifts at the hospital. I'm going to visit Margarita at her house sometime this week to say hi to her parents.

We then explored the two hospitals. Both had the typical departments--ER, labor & delivery, pediatrics, ICU, etc. The hospitals housed at least 6 patients per room. There is no circulation whatsoever and dogs meandering around. Not much sanitation or hygiene to say the least. We roamed the different departments. I observed some very sick patients--a 1 lb baby (2 months premature), a 7-year-old with malaria and malnutrition and a 1 month old baby suffering from epilepsy. It was pretty heartbreaking to see. Also, I watched many patients wheeled OUTSIDE from one building to the OR. The nurses would just take off their shoes when stepping in the OR. I can unfortunately imagine many terrible infections after entering that room. At least the labor & delivery unit in the hospital is better than in the villages where they have witch doctors deliver the babies. If the woman hemorrhages, the witch doctor can't do anything. Kind of unbelievable.

After touring the hospitals, we walked around town to buy the eggs for the malnutrition program. We had a classic Indonesian lunch. I really had a taste of the town life of the Sumbanese.

Finished the day off with another stand-up paddle board session in the ocean with a few people here at my hotel. Watching the sun set while on the ocean was gorgeous.

Thanks for reading,

Sunday, July 3, 2011

The Beginnings

Hi All!

I arrived safely in Sumba last week. Since then, I have been very busy coordinating translators and transportation for my project. Last week, I met Rainy Octora who is the malnutrition coordinator for the Sumba Foundation. I followed Rainy out to the Larawatu Village last week to observe the beginnings of the malnutrition program there. Larawatu started receiving Sumba Foundation aid since May. I was amazed to learn that households consist of 7-10 children in the villages; which means a greater distribution of food, resources, and water among the children.

At Larawatu, Rainy and I weighed the children and recorded the information. It was relieving to see that most children had put on approximately 2-3 lbs since May. We then passed out 7 eggs and milk for the week. Rainy has also started teaching the mothers at Larawatu how to plant and cook. They are now taking turns cooking the green bean (full of protein) and coconut milk porridge. Water is still a big issue for Larawatu village because of its isolation. The mothers in the village wake up at 3 AM to pick up water from a source about 2 kilometers away.

Sumba is unreal. Outside of my project, I absolutely love exploring the culture and heritage of the people. I have learned a few Indonesian words: apanama (name), umur (age), and DA!!! (which the kids scream at you to say hi and bye). Despite some sickly-looking children, they are very enthusiastic and energetic.

I can't wait to continue my project tomorrow.


Saturday, July 2, 2011

Serendipity’s Flowers

This is a story of how serendipitous fate can be sometimes. Last week as we were on our way to clinic, our car slowed down just enough for Dr. Woodrum, a visiting doctor from the US, to notice some flowers growing on the side of the road. They were pretty little purple and white flowers, and Dr. Woodrum immediately decided they would add a pleasant touch to the Burkitt's lymphoma center down the street from our hostel. So the next day as we headed out to clinic, we also brought some gardening tools to uproot the flowers.

When Dr. Kawira, the resident doctor of Shirati, saw the flowers, she remarked how much they looked like Periwinkles. Sure enough, these flowers turned out to be Periwinkles, which is scientifically called Vinca major. Vinca major is the same flower from which the drug Vincristine is derived. Vincristine is a broad chemotherapy drug and is used in the treatment of Burkitt's lymphoma. I couldn't help but marvel at how appropriate it was that Dr. Woodrum, without knowing it, planted Vinca flowers for the Burkitt's lymphoma center.

Searching for our patients

Interviewing patients these past two weeks have been very interesting. Dr. Kawira gave us about 20 case files of her previous patients for Reshem and I to search out to interview, but I had no idea what an adventure this task is. With a guide and translator, we set out on rented motorbikes to search for these patients. The first day was relatively straightforward. We found the first 3 patients with ease. We rode to a neighboring village and within minutes we found ourselves at their homes. Each passing day of interviews, however, has been increasingly difficult because we had to travel farther and farther from the main road and deeper and deeper into the hills. Just a few days ago, we were riding through corn fields to reach the patient's hut. Today, we went off-roading for at least half an hour to get to the patient. At several points, the road was so impassable that we had to get off our bikes and push them through the rocky crevices. It was so difficult and took us so long to get to some of these patients that I marvel at how they ever able to travel to the hospital and clinics to get treatment. Even though it's been quite a trek getting to these patients every day, it's been well worth the effort just hearing their amazing stories.