INDIA: Oh rain!

When we first came, there was not enough rain. No hydro-power means no electricity. Then there was copious amount of rain which somehow also meant no electricity. In the past few days we've been dealing with mold and fungi that have infested in our home due to the high humidity. Now it is clear, full of sunshine. Good news? or so we thought. Well, we've been told it means higher frequency of infections. There is no win.

Dengue fever incidents are high in our hospital and within the last few days, they have been an influx of school children admitted for viral infection. They suspect it is the seasonal flu. Kenchanahalli is a 10 bed hospital but they've been holding 20-25 patients in the last few days. Hopefully it is just part of the season. Here's a pic of us at the Kabini dam. Posing for the rain Gods!

TEAM TANZANIA

 Introduction

Our team of UCSF and MUHAS students is currently congregating at the MUHAS campus in Dar es Salaam Tanzania to work with the Academic Learning Project.

UCSF and MUHAS have an established collaborative partnership aimed at enriching and improving medical research and training on both campuses. The Academic Learning Project (ALP), which we will be helping with while in Dar is a research initiative founded by the Bill and Melinda Gates Foundation. The long term goal of the ALP is to improve the health of the Tanzanian people by increasing the numbers of health care professionals in the country. There is currently a critical shortage of trained health care providers in Tanzania, with only 3 physicians per 100,000 people and 13 nurses for 100,000- well below the WHO recommendations. The ALP is intended to be a three year project that will produces revised undergraduate and graduate curriculums that will allow practitioners to meet the health needs of Tanzanians. It is hoped that the ALP will serve as a model of a successful and mutually beneficial partnership between African and American Universities.

We will be working on the Tracer Study for which we will be interviewing recent MUHAS graduates, their employers, co-workers and patients in order to identify competencies and deficiencies in their training from MUHAS. This needs assessment will serve as the basis for future curriculum revisions and development.

While working on the Tracer Study we will be partnering with current MUHAS students, and will be paired according to discipline (for example a UCSF dentistry with a MUHAS dentistry student etc). Our team consists of students from all faculties- medicine, dentistry, pharmacy, nursing and public health.

Kwaherini, 

Molly, Evan, Lin, & Joy

india - mysore and water

(written July 2, 2009)


The monsoon rains have been delayed this season and reservoir levels are dropping, affecting accessibility of drinking water in the region, crop production, and the hydropower on which this area depends. We have been mostly without electricity here in Kenchanahalli.

According to the Deccan Herald, Wednesday July 1, 2009, power cuts will continue across the Karnataka state as we await the late arrival of the monsoon rains. The delayed rains are having an impact on power shortages throughout the country, and many states have banned private producers from selling power out of state. The Deccan Herald further reports that with the current reservoir levels (see chart below), power can only be generated for another week; if the low water levels cause generation from the hydroelectric power stations to cease, Karnataka state will need to purchase at least 30 million units of power (units not specified) daily and will be facing further power outages.






Note: adapted from the Deccan Herald, July 1, 2009, p5




In addition to the reservoirs that serve Karnataka listed in the chart above, the Kabini Reservoir and Dam were constructed in the 1960s, providing hydropower to the growing areas around Mysore. The Swami Vivekananda Youth Movement (SVYM) clinics in Saragur and Kenchanahalli where we are working serve tribal communities, many of whom were displaced through the development of the Kabini Dam and the designation of the surrounding area as a tiger protection reserve that forbids human habitation. For 30-40 years, these tribal communities have been living on the margins of modern society, attempting to maintain cultural traditions in displacement. Tribal communities is the term used by local NGOs, the government, and community workers to refer to the populations that were traditionally forest dwelling. These displaced populations are particularly vulnerable to exploitation and poor health in the forced transition from traditional ways of life to surviving in a modernizing society (source: SVYM brochure and video).

[see later blog entry for an update about the arrival of monsoon rains]

TEAM KENYA...to do list

The fisherfolk hotline aims to improve fisherfolk’s ability to sustain their HIV treatment, both medication administration and appointments, and therefore improve the effectiveness of treatment. The implementation of the hotline will be continually monitored and then evaluated six months after the start date on the basis of the number of calls, the type of service rendered by the hotline, feedback from an interim focus group of fisherfolk, and the number of missed appointments/medication pick-ups compared to the number missed before the hotline’s implementation.

One of our tasks is to locate a list of all the clinics in Suba and create directions to each one. This is no small tasks considering that there are over 30 clinics and traditional addresses in Kenya are rare so directions will have to be based on landmarks. This information will be available to call receivers so that clients can be informed of clinics they can visit in the area they are working.
Another task is to create medical cards for all enrolled clients that may use the hotline. This way when a client is referred to another clinic, that clinic knows the client’s allergy information, latest CD4 count, current medications, and co-morbidities.

Once we create the clinic list and medical cards we will hold a focus group with fisherfolk and role-play how the hotline will work so that we can get feedback, make adjustments, and publicize the line. This is not an exhaustive list of what needs to take place in order to implement the hotline but these are our focus at the moment.

Our work-day pace tends to go like this: motorbike from our home stay to the clinic, help with vitals and client triage in the mornings, take lunch with FACES staff, work on our fisherfolk hotline project in the afternoons, and then taking a 1 hour walk back to the home stay.

TEAM KENYA

The three of us, Teja, Michelle and Diana are based on Mfangano Island, Kenya where we are collaborating with Family AIDS Care and Education Services (FACES). You can read about this organization and watch their documentary on their website, www.faces-kenya.org/

Our focus is to get a hotline running for fisher-folk in the region. FACES has asked us to work on this because the fisher-folk in Suba, which includes Mfangano Island, are a particularly vulnerable group of clients within FACES. This is in part because they are migrant and their schedules are highly volatile, making them subject to weather conditions and migration of fish within Lake Victoria. The nature of their work makes it difficult to keep up with Antiretroviral (ARV) treatment and clinic appointments and causes them to suffer from HIV complications. Secondly, there are jaboya, a subset of fishermen that solicits transactional sex from women in exchange for their high-value catch. This increases the incidence of HIV.

Chas Salmen who has spent much time with the communities on Mfangano and who will meet with us here on the island at some point provides an interesting perspective for understanding the epidemic in this region. In his thesis, “Towards an Anthropology of Organic Health,” he writes that HIV in the region “represents the dynamic intersection of microbes moving across time and space, a colonial history of marginalization, structural violence imposed by a global whitefish industry, local political structures of competition and rivalry, and the embodiment of desperate economic conditions.” His writing gives context to the HIV epidemic on Mfangano Island, demonstrating how, in his words, “powerful socioeconomic forces and deteriorating ecosystems contribute to illness as much as any pathogen.” In order to convey more context on HIV on Mfangano Island we will try to link the intro and first chapter of his thesis to this blog.

The goal of the fisherfolk hotline is to facilitate fisherfolk’s ability to pick up their medications in a timely fashion and keep their clinic appointments even when work takes them far from their usual clinic. Through the hotline clients will be able to find clinics close to where they are working, reschedule appointments, and arrange medication pick-ups at nearby clinics.

The following blog entry will better detail what tasks we have ahead of us.