nets for kids

inspiring medic

Here I am at E-- and I go to bed at 8pm and wake up when the roosters start cocking, which is about 4am. It’s really quite frustrating, but it’s the price I pay for working in such a sexy industry. Today we debriefed with the malaria medics and one new major issue that has come up is lack of continuity. Medics leave and they don’t train the new person who is assigned to take over before up and going. Sometimes or most of the times the medicine cannot be accounted for. Sometimes we know that the medic has taken the medicine with him and sometimes we just don’t know where they left the medicine.

Despite all these challenges, it’s heartwarming when you debrief with a medic and all their data and accounting all make sense, and he’s followed every instruction and then I feel proud that this village health worker approach can and does work. H--- L-- from the Y--- area manages 11 villages in a particularly unstable internally displaced persons area. Yet, as he’s been trained, he’s got a village health worker in each village that provides quick diagnosis and treatment to every villager in each of the target villages. When the B Army comes near a village, and many villagers flee into the jungle, fearing direct confrontation with soldiers, he is alerted to the news and he’ll make sure and go to where the villagers are hiding to make sure that they are being monitored and treated for malaria. They are unable to carry their belongings let alone their insecticide treated nets with them when they’re hiding in the jungle. He’s even set up a malaria committee in each village who actively participate in health education and recruitment of village health workers. His job is to train and retrain the village health workers and make sure they’ve got enough supplies. He makes his rounds his areas and stays in each village several days at a time when monitoring their work. He also trains them as a group, let’s them practice and then debriefs with the village health workers, in order to address their questions or difficulties. He is keen on building up their confidence and skills in to insure that they give proper malaria education and treatment. He says that without the help of village health workers he would only be able to cover just a few villages. However, with their help, he’s able to cover almost an entire population of about 2000 villagers. He’s happy to be the malaria medic. I can tell, he’s an older guy who is always cheerful and always smiling, and it’s infectious, his positive attitude. He always makes small talk with me and anunciates his words so that I understand clearly and he is I’m sure quite charismatic and fun to learn from. He also makes the tastiest tomato and onion and chili pepper salad, which I enjoy very much eating on a hot jungle day, after 8 hours of training in a bamboo hut.

Rambo the movie

I'll be going inside to a camp of internally displaced persons in eastern b---- to conduct a malaria workshop. It's pretty close to the border, but it's also only 10 minutes away from three b---- army camps. And we have to cross the river accompanied by either the thai border police after greasing their palms (i think that's the term) or the ethnic armed group. Thousands of people fleeing their villages now live in this camp. There have been major military campaigns in northern k---- state, which has resulted in 6 of our program sites to cease operations. There is speculation that many more clinics and villages will become inoperable this coming year as the b---- army plans to push force a ceasefire with the k----. It's bizarre that my life parallels this ridiculous movie coming out, the same weekend I'm heading in. I will be incomunicado for about 9 days. Will write when back! Then i'm going up to chiang mai to see this movie for myself.


link to rottentomatoes RAMBO

LYCM!

mosquito repellent

you guys are probably pretty tired of me talking about malaria this and malaria that. too bad. anyway, this one's a bit more personal. i've started a new mosquito repellent regimen - raw garlic. it was an idea from a friend who labored finding non-smelly garlic capsules in borneo. i say "why bother with the pills"? raw garlic seems the way to go - it's cheap, it tastes great, and i think it's got a bunch of other health benefits that i can't recall. a handful of us here have started the garlic regimen together so we can all neutralize the "healthful odor" we are emitting from our bodies. we all stink together. and why should i even care? the only boy i want to kiss is 13,000 miles away, and i don't think he'd even notice me popping several of these throughout the day like candy. so far so good. i've only been bitten twice in the past 3 days.

BURMA'S INDEX
Percentage of ruling military junta budget allocated to arms: 40

Per capita expenditures on healthcare by Burmese ruling military junta: $1

Total earnings in millions per year for selling natural gas to foreign companies: 40

Rank of Eastern Burma in terms of worst mortality rates for children under 5 in world: 2

Number of years current military junta has ruled Burma: 19

Number of years Aung San Suu Kyi has been under house arrest: 13

Percentage of deaths that malaria accounts for in Eastern Burma: 40

Cost of one insecticide-impregnated bed net to prevent malaria: $5

Average percentage change of malaria prevalence once village implements Karen Malaria Control Program: -68

Cost of one rapid diagnostic test for malaria: $0.80

Number of megawatts of electricity that will be generated by 5 dams that will be built along the Salween River: 10,000

Number of Karen civilians the dam project has displaced so far: 210,000

Percentage of the new energy proposed for displaced villagers: 0

Number of persons needed to test positive in order to consider a village endemic with filariasis: 1

Number of health workers working in Eastern Burma that tested positive for filariasis out of a sample of six: 2

Official estimates of filariasis infections in Burma: 2,000,000

Percentage of villagers in Eastern Burma that were forced to move from village in 2004: 9

Odds of child being malnourished if household was forced to flee from their village in the past 12 months: 3 in 1

largest hilltop village in the world

One word comes to mind when i think about this place and our trip - barriers. and signatures. Our health program workshop was an uphill battle, figuratively and literally. Starting from the numerous permits and tourist restrictions to the overwhelming level of bureauracy that we faced every day (to get out of this freagin insurgency-ridden town, i needed to walk through 5 security checks and get 4 signatures just to board the plane. Even my carry-on needed 2 stamps) to the fog that almost forced us to reroute our trip in order to catch all our connecting flights through the rough terrain (a 1 hr plane equals about a 35 hour busride), everything was a challenge. More importantly, other barriers included lack of communication, lack of coordination, high cost medicines, restrictions on supply chains, language barriers, lack of human resources, lack of education, little to no funding and political instability. Probably the biggest barrier was ignorance that perpetrates the minds of the government officials. The ministry of health of this state was a racist, blaming the ethnic minorities on pretty much all the problems of her state and beyond. "They bring over drugs, HIV and malaria and crime". During dinner at her house, she explained to us the horrors about 'bee wee' a local yeast that supposedly quickens the fermentation of bootlegged liquor here (this is a dry state) that the burmese use which causes major bleeding and ulcers all the while she is forcing fosters beer and red wine down our throats that she illegally smuggled in her government issued car. she claimed that rape was the biggest crime and that a chin (burmese ethnic minority) is usually the perpetrator. She also said that hiv/aids is a consequence of bad things a person does like sex work and druguse, but it you get HIV, at least you don't die right away and you have time to pray and repent for your sins. Whereas with Malaria, it doesn't discriminate between [good and bad] people so this is a disease that she is fully addressing in her state. Her idea of fully addressing this health problem? Passing out untreated bed nets at drug depot centers (that don't serve migrant populations), using sub-par antimalarials, and breeding drug-resistant malaria by giving chloroquine to the army as a prophylactic once a week. besides her being a big disappointment as a strategic health partner, everything else was inspiring. The health workers in our workshop were eager to learn about the health status of their people, they're equipped and ready to go out in the field to do some malaria screening and data collection. But we're still figuring out channels for drug supply distribution. The 4 of us had a ball every morning eating our dal and chapati, where the waiter, having finally figured our routine, out didn't seem to mind serving us anymore. And our also routinized lunch over at Hotel Chief was always good, where the menu read "designed for smart people". We're now in Kolkata, happy to be sitting in this airport for several hours and i'm looking over to see tom and luke trying to connect to each others' laptops, chatting away about the next program they'll design, and once in a while asking me for the umpteenth time if i don't just want to head down to maesot with them for another week of more workshops. As for me, i'm health-programmed out and all i want is to be home, taking a crap like a normal person and then taking a hot shower and extracting the multiple layers of exhaust out of my nostrils that was blown into my face every day for the past week or so in this hilltop of a city.

The data (obtained from biannual household screenings) show a decrease in proportion of villagers tested positive for Malaria where interventions were implemented.

back on the T/B border

Oh soo wah my peoples? (that means how are you)...I'm back in Thailand, it's great, as usual. Am here to facilitate a couple workshops and help with some data (1. malaria control - implementing a new artesunate based combination therapy and 2. program planning/mortality/human rights data collection training). It should be interesting given the recent flurry of military aggressions against the ethnic minorities, particularly the karen, since the junta moved their capital away from Rangoon to a city farther north (and closer to karen state). I've been pretty swamped and haven't had much of a chance to write. I actually just got back from a village that I can't disclose the name of b/c the village is 'inside"... plus, Judy C was out here and we totally got to bond during our 4 hr truck ride that went from "what fun sitting back here with the wind blowin in our hair" to "what the fuck. it's raining and we have to keep each other warm with body heat." Because of all the rain, we rode a tractor into the hills as far deep as we could go thru corn fields and then walked the rest of the way. There we did some survey pretesting with the villagers and reviewed their malaria control program, in addition to teaching yoga to the entire village, after which we had a big longan fruit ceremony where they clinic staff sang their village theme song. I'm excited for this new survey b/c we'll be getting some new information - like the total goiter rate, and whether or not an area is endemic with filariasis. (that's the parasite that causes elephantitis of the balls, legs, arms. apparently, you only need to find 1 positive to consider an entire area endemic. we tested out the diagnostic tool on a couple folks here in mae sot and found 2 out of 6 were positive. scary.). I will definitely have to take a treatment course to rid my body of any filariasis worms. A little DEC+the good ole albendy. Did I mention the trauma workshop where the medics used pigs that were injected w/etomidate and then suffocated as subjects to train tracheotomies and other things that these backpact medics have to do due to landmine explosions and other jungle-related injuries? other than that, life is pretty quiet here - no dog attacks, no streets flooding. i've been eating great a ton of green papaya salad. i'll be heading back to LA soon where i'll have to continue my job search, probably go back to my old research place and kiss some butt. speaking of which, i made out witha couple boys in LA before i left. hot. omigod, i gotta continue some translation work...sawadeeKAAAA!!!