Tragedy on the East Coast

I feel like I would be telling a lie or living out an important event in my time here if I didn’t write this blog post as I have been contemplating doing and not doing since the weekend. If I was going to write a disclaimer for this blog, it would be that though I have tried to keep details to a minimum, I still try to share with you what I have seen and heard. It is also important for you all to know that I am a bright girl and I am safe. On that note, I was smart enough to call my parents instead of just letting them read this, so don’t worry. I am going to call on the help of the BBC news report ( http://news.bbc.co.uk/2/hi/americas/7212861.stm) to tell this story with facts as well as touch on some local newspapers, but the story is very hard to find in them.

This is the longest it has ever taken me to write a post.

My usual routine on a Saturday morning is to sleep in a little bit, make some breakfast and watch an uplifting Hallmark or Lifetime movie (depending on which signal the station feels like borrowing). I had a pleasant surprise to be watching “Back to the Future” which I had never seen. Michael J Fox was stuck in the past when the movie was interrupted by breaking news.

Early that Saturday morning there had been a weekend rampage in only 20 minutes where 20 to 25 gunmen had stormed homes … to murder… massacre… execute… 11 innocent people in a small village called Lusignan east of the capital Georgetown where I live. Among the dead were five children. The motive was not robbery because they had nothing to steal, but the intention was to kill. I have always found it difficult to stomach the newspaper reports here with their details and pictures that would never be published in Canada, but the surprise of the report and the shock of the news did not prepare me to be taken with the camera crew into the homes of those who had been killed only a few hours before.

“How do people recover from the brutish blitz of these gunmen and the trauma they wrought and imprinted indelibly? Like the horror of the two children in the final seconds of their life as they cowered and sought the protection of their mother who was also brutally gunned down. Or the mother who saw her children lined up before her eyes and mowed down. Or the wife who saw her husband being dragged from under the bed and being blasted in the head. Or the child in hospital barely clinging to life unaware that two of his cherished siblings and his father are no more.” Monday, January 28th 2008, Stabroek News, editorial

The news reports shocked me to the core and I didn’t think I was going to be able to stomach the video, quite literally. I was even more disturbed as the day progressed and the various channels continued to cover the story and fight for details, new perspectives, and my usual reliable channel for a good Hallmark or Lifetime movie, proceeded to play the series of movies based on the Vigilante and a collection of Steven Segal’s movies – no themes of retaliation, revenge or taking matters into your own hands there.

It is thought that the murders were committed by a criminal gang led by one of the country’s most wanted men, Rondell Rawlins (also wanted for the murder of a government minister in 2006). He is accusing government forces of kidnapping his pregnant girlfriend and placed telephone threats warning of what would happen if she was not returned. There is currently a G$30 million reward for information leading to his capture.

There are a million and one rumours about the response of police to the attacks, the whereabouts/status of the missing pregnant girlfriend, the location of the gang, and their next attack that I don’t feel are worth repeating. Somewhere in them I am sure is the truth and hopefully somebody finds it soon. Taxi drivers are an excellent source of background information.

As if the act in itself were not enough to cause considerable grief, Rondell Rawlins and his gang are from the ethnic African community while the village that was attacked is mostly ethnic Indian. The concern now is an increase in ongoing racial tensions that usually ‘simmer’ below the surface. Residents in the area are displaying their grief and protesting the massacre as well as their perceived lack of protection at the time and call for safety by marching, building roadblocks and lighting fires.

The Canadian High Commission has sent out an email that recommends avoiding certain areas and promoting safe practices. I had lunch with a High Commission employee, his wife and the other CIDA interns which was nice to be able to hear more facts than speculation and sensationalization found in newspapers and to discuss our impressions of the situation. Essentially nobody knows what could happen next, but the obvious hope is that after the funerals/cremations and the anniversary on the weekend, things will settle.

In a country of 760 000 where everybody knows everybody, death of any kind touches everyone, but this senseless crime has touched everyone on another level for the pure disregard for the value of human life and senselessness of the act, done solely to invoke fear and terror. I was told by my mom on Sunday night that this year at my grandma’s church and I would assume other Catholic churches around the world, the World Day of Prayer intentions are for Guyanese women - a decision that was made many months ago. The actions of last weekend and the ongoing racial tension in this country leave no doubt in my mind that this day will now take on a new purpose. The Guyanese women need all the prayers they can get as they raise their children hopefully to respect other races, to not join gangs and to promote peace in their country.

Joseph and the Amazing Technicolour Dreamcoat

I think my first introduction to the music of Andrew Lloyd Webber and lyrics of Tim Rice for Joseph and the Amazing Technicolour Dreamcoat was on a dubbed tape that my mom had. I don’t think I understood the words or that the songs wove a story, but I love the variety of music that pulled my heart strings or made me feel like dancing.

I can’t remember how old I was when I saw Joseph performed in Toronto with Donny Osmond in the lead, but I do remember my mom swooning because she was certain that he was singing straight to her. The production was spectacular with lights, set and costumes.

I was so proud of the performers in the performance of Joseph at the Senior El with my Adam in the lead as Joseph. It was a big step for him to again take the lead, plus seeing some of the students I have known since they were little, discovering the amazing inner talents.

There is now a special place in my heart for the performance of Joseph and the Amazing Technicolour Dreamcoat, done by the Woodside Choir and friends in Georgetown, Guyana at the National Cultural Centre. I have no excuse for why this post was not up last week when I first saw the performance, but here it is now! I didn’t quite know what to expect, but I had my hopes since the musical was originally performed after Christmas and was brought back for one more weekend due to popular demand. I was not disappointed.

I feel the Cultural Centre was probably built in the 1970s with a lovely brown interior, fortunately air conditioned and a dress code including no jeans that is apparently strictly enforced. I knew that it was going to be a good night the second the Narrator started singing – a tremendously powerful voice that showed no hesitation hitting the high soprano notes that her role required. I was a little worried at first when I saw Joseph and he looked to be just a boy, but his beautiful tenor voice assured me that he was up for the part and he definitely impressed me. In total, I think the supporting cast was approximately 20 adults, 15 children (5 of whom were dancers for Joseph’s dreams) and an additional supporting choir of 10, with many cast members playing more than one role.. The sound system itself left a little to be desired at times, but did not hide the talent of the cast. I am left with no doubt in my mind that Joseph and the Amazing Technicolour Dreamcoat was meant to be accompanied by a steel band, though the keyboard and trombone were a nice touch. The set was simple, but did the job well and the effort put into the costumes was obvious. The only disappointments I had were the low-energy performance of Go, Go Joseph that could have had more excitement even in a low budget production and the non-Elvis Pharoah, who unto himself is a very gifted man, but there’s nothing quite like an Elvis impersonator.

Although less spectacular than a downtown Toronto musical and no personal connections like a Bancroft performance, I felt inspired by the Guyanese performance of Joseph and I really hope that the director, cast and choir continue to perform for the people in Guyana. Here’s hoping they have another performance of something before I leave!

False Alarm, kind of...

Note: update on my health, no worms involved

I had an allergic reaction to the ciprofloxacin that I was taking to battle my post-hookworm war infection. I've had a similar reaction to cheap bandaid adhesive where the "spot" or in this case my hands, delivered an itchy rash consisting of tiny blistery bumps. Quite a nuisance when you consider how much you use your hands and it made it uncomfortable to move them. I couldn't think of anything new that I had touched and found on a list of rare side effects (pick me!) that ciprofloxacin can cause various skin reactions including rashes and sensitivity to sun. After three days of antibiotics, I went back to my lovely doctor who prescribed me a strong antihistamine, Piritin, recommended using my Fourderm cream on it and approved my decision to stop taking the meds. I took Friday off because after the first dose of Piritin knocking me out, it seemed to have the opposite effective of keeping me up so I didn't sleep at all on Thursday night.

On Saturday, I was flipping through a book I had found at work entitled "In the village where there is no doctor" which is essentially a how-to book for locations where there is no doctors (go figure from the title) and looked up skin rashes. At which point I diagnosed myself with scabies and freaked out. The thing with scabies is that it looks like an allergic reaction and has key areas/patterns that it develops, including on the hands, starting between the fingers. Um, pick me!? I couldn't tell whether my allergic reaction was getting worse or better on Saturday having stopped the meds for two days, and still experiencing crazy itch. A panic phone call to my sister to google more information for me helped me make a plan.

Luckily, starting on Sunday and continuing, the itch has gone and the rash is fading. False alarm, knock on wood. Whew.

Note to self: allergic to ciprofloxacin. Here's hoping I don't have any gastrointestinal problems because it's the antibiotic that travel doctors prescribe to you to take with you, just in case. If anyone is interested, I have a good supply that I probably shouldn't use.

"The World is a book, and those who do not travel read only a page." ~St. Augustine

Not for the faint of heart…

WARNING: If you are my mom or dad or sister, I recommend not reading this entry. If you are printing this blog for my grandma, you have the responsibility not to share this entry with her. If you are queasy about diseases or bodily functions of any kind, I recommend going back to the Christmas entry and pretending you never saw this one.

THIS POST IS FOR YOU: If you have an interest in weird diseases, healthcare in Guyana or my general health, you can read this entry. But I warned you.

My first doctor visit was a week or so after I moved into my apartment in October. I actually don’t think I told my mom about that visit because I didn’t want to worry her. Bugs love me. I knew that in Ontario. But mosquitos are different here, besides being the kind that can carry lovely diseases like malaria and dengue fever, my body also reacted differently to them. One bug bite would swell up with a red circle about two inches in diameter – this was not helped by my talent of scratching in my sleep, which would often mean the bite would create a bruise. I won’t go into more details, but the reaction lasted long enough and was painful enough that I thought I should make sure they were mosquito bites and not bed bug bites or something… Wallis’ son was sick at the same time so she sent me with him to her paediatrician. The chairs were really little, but she was very nice and gave me some miracle cream to help the redness go away and extra powerful oral antihistamines. I would like to take a moment and promote Watkins bug repellent, an excellent cream made in Winnipeg. There is a supplier in Bancroft that my mom can put you in touch with – I got a stocking full and when I remember to put it on, no bug bites!

This background information is important to explain why after my family’s visit to Baganara, I wasn’t overly concerned about some bug bites on my feet. Sure they were itchy, but give it a week and they’ll go away. The problem was, they didn’t go away. It was like they were getting itchier. And there seemed to be more than the original three that were in the arch of my foot. And in between my baby toes felt like they were on fire. Upon closer inspection, I scared myself because it looked like there were more bug bites and a path leading from one bite to the next. I decided to ignore it and that it would get better – not the smartest idea I’ve had, but it only lasted one night. I went to Maria the next day for a second opinion who confirmed my suspicion and sent me to the doctor with strict orders to report back.

Time for my second doctor visit. I showed Kala my feet and she gave me the phone number of a doctor specializing in parasites. Dr Validum works at Woodlands Hospital which is a private hospital just one street away from where I work. After some interesting directions, I found his office and as per instructions on the door, knocked and sat until the nurse came to talk to me. I arrived at 11am and was seen by the doctor a little after noon. I went in and he confirmed my diagnosis of worms, more specifically hookworms. My white skin made the track marks appear extra pink so he asked if he could take a picture, because he rarely sees such a textbook case. Lesson to be learned: don’t walk barefoot in the sand. He prescribed albendazole (an oral, anti worm drug – 400mg a day, five days), Fourderm cream (topical antibiotic – apply twice daily) and gravol. I was given instructions to soak my feet in antibiotic soap, followed by epsum salt and apply cream, twice daily. The consultation fee for the doctor’s visit was $2000 (approximately $10CDN) and it was my first experience paying to see a doctor.

I went to the hospital pharmacy where thankfully there wasn’t a line so I didn’t get lost in the system. At one station you drop off your prescription and pick up three copies of your receipt. You take the receipt to the cashier to pay where you get two copies back that have been stamped “PAID” which you take to the delivery counter and pick up your drugs from the pharmacist, leaving one copy there. The total cost was around $500 ($2.50CDN).

That night was the worst firey, burning itch yet. This sensation I now know is caused by the burrowing action. I know they aren’t visible to the eye, but I still contemplated surgery to remove them or amputation of my feet on my bathroom floor. Fortunately the only tool I had was a steak knife, no proper means of cleansing the area and enough sense to know that it was a bad idea. After two doses, the itchy, burning feeling had stopped. I had one day of swelling around the track marks, but then they decreased in size and increased in pink colour. Certain areas looked like blisters which caused me some concern.

I went back to the doctor yesterday. The swelling had been an allergic reaction to the burrowing and dying worms. The bumpy areas were signs of an infection. He explained a little bit more to me about types of worms, but essentially these worms can’t get any further than my feet. If for some reason, I had ingested them, we would have an entirely different set of concerns, but that doesn’t seem to be the case. He prescribed ciprofloxacin to fight infection, more Fourderm and iodine. He sent me over to the outpatient ward to have the infected areas (also known as “bleps” apparently) opened, cleaned and dressed. He stressed the importance of cleansing the area atleast once a day, dressing it and keeping it covered to protect from all the dirt and dust around – meaning wearing socks for the first time in almost a year.

The outpatient room is similar to the pharmacy in that I had to get the price, go to the cashier and then wait in line. The doctor had called over with instructions to go with my note so they were expecting me. It was a first experience for the two younger nurses to see the results of hookworms, or atleast the resulting infection. I don’t know what I was expecting. The nurse had a pair of blunt scissors that I had seen, but never used, in my anatomy kit, gloves and a cloth with soap. I almost think that I could have done it better on my bathroom floor, but she was very thorough though a little rough. She sent me off with the areas covered in antibiotic ointment and slightly nervous because she saw no need to cover the areas.

I am taking my oral antibiotics and nursing my fresh wounds. Also keeping my feet elevated to hopefully minimize pressure on them and increase healing - which gets me a few odd looks when people walk by my office and I'm lounging at my computer with my feet up. I have minimized the details of the physical signs of being infected with hookworms because I know just the thought and some details are enough to gross people out, but if you are so inclined, I do have pictures of my progress and would be more than willing to provide more details.

Lesson learned. You won't catch me with barefeet in the sand again.

International Health Mentorship Program

Shortly after I arrived in Guyana, another intern suggested I become a health mentor and share my experience. I have two medical students that I am mentoring. Below is a description of the project as well as some resources that were sent out in an email and I thought I would share for those who are interested in health systems and global health. If you are a medical student or an international health professional of any kind, I recommend getting involved!

From http://ihmp.cfms.org/:

The International Health Mentorship Project (IHMP) is a Canada-wide project that began in November 2006. The project links experts in international health and development with medical students for the sake of communication, knowledge and network building. We believe that in order for future medical professionals to be most useful internationally, they must learn from those professionals who are experts in the international health sector. We believe that through education, health professionals in Canada can be more culturally sensitive, sustainable in their approach, and effective in global health.

From email by IHMP Resource Group:

“1. WHO: Health Systems. Found online at: http://www.who.int/topics/health_systems/en/ .

This is a great place to start. This site provides statistics, publications, general information, and related WHO links to topics in health systems. It provides a good foundation for grasping the broad realm that is information systems, and their importance in the effective delivery of healthcare.

2. WHO: Management for Health Services Delivery. Found online at: http://www.who.int/management/en/ .

The site provides a very brief and theoretical overview of health management systems and models. Directed at health management professionals, there are a number of modules, tools, topical resources, and current news updates on health management practices.

3. WHO Health Metrics Network and Global Atlas*. Found online at: http://www.who.int/healthmetrics/en/ , and http://www.who.int/globalatlas/default.asp*.

What are institutions and world leaders doing about environmental health issues? Check out this site for an overview and updates on some WHO lead projects.

4. Improving Health for the World's Poor: What Can Health Professionals Do?** Pages 11-18. Found online at: http://www.bma.org.uk/ap.nsf/AttachmentsByTitle/PDFImprovinghealth/$FILE/improvinghealth.pdf.

Targeted at health professionals, this report discusses the health effects of both climate change and clean water. Each chapter concludes with some suggestions for action.

In addition to written resources, there are some multimedia clips online relating to healthcare systems. The following photoessays are found on the BBC website, and highlight the improvements, hope and resilience of healthcare systems in Kenya and Tanzania .

Found online at: http://www.who.int/features/africaworking/en/index.html ***”

* I really enjoyed exploring the Global Atlas site. With the click of a mouse, you can look at the HIV prevalence in adult incident TB cases or the gender distribution by occupation in health workforces. The stats are as up-to-date as is available.

** This article provided a snapshot of some health system and global concerns, including climate change, clean water and obesity. Each chapter was presented clearly and ended with a “what can you do” to make a change.

*** These photoessays were interesting to read/see because I know interns working in Rwanda and Tanzania, plus the electronic health information system is similar to what I am doing here, only a different approach.

When I get some more resources, I’ll be sure to share!!

Family Christmas

They arrived safely. On time. A little tired. And a little emotional when they saw me at the airport to greet them, not just a taxi. I spent most of Christmas day, patiently waiting – spacing out phone calls to family in Canada, watching Shrek 3 on TV and watching the clock. Mrs Boodie took me with her to her family’s Christmas dinner where I was adopted and well fed with all sorts of wonderful Christmas food from the traditional turkey to new Christmas foods for me like corn pie and roasted pig.

We stayed at the El dorado Inn, my first home away from home. Boxing Day was fairly low key with brunch at Mrs Boodie’s followed by a “20 minute” nap (3 hours later) and take out of delicious Church’s fried chicken. For the next few days, I took them to the beautiful historic sites of Georgetown, the places where I work and various stores, groceries and restaurants. They saw the seawall, Umana Yana (Amerindian benab), St George’s Cathedral (tallest wooden building in the world), National Park with manatees, Promenade Gardens/Botanical Gardens with various plants and trees, Castellani House which houses the national art gallery, and the 1763 Monument in memory of a slave who led a failed rebellion. I took them to the grocery stores where I shop and the fruit market to introduce them to such Guyanese treasures as sweet fig and apple bananas, mangoes and sapodilla. No trip would have been complete without experiencing a blackout when we were dropping the vehicle off and at the restaurant that we went to dinner for on Friday night. Delicious breakfast every morning and perfectly selected meals the rest of the day from Buddy’s Mei Tung for Chinese food, German’s for Creole (favourite lunch food) and Celena’s for the ocean breeze and fish – I am a good tour guide!

On Sunday we went to Kaiteur Falls. The family had seen the pictures, but I still don’t think they quite pictured its magnitude and its beauty. It was a bit cloudy, but that kept it cool for walking between the different viewing points. We got some great pictures – the best is the family on an overhang with the falls in the background. We didn’t quite mention to Mom that it was an overhang; she thought it was just a point out on the rock and she still held on for dear life. From Kaiteur, we went to the Baganara Island Resort. It was the perfect place for me to hang up my tour guide hat and do some serious liming. Even in the rain, the place was beautiful and the main house had hammocks hung and comfortable couches to relax. We took a trip by speedboat to Bartica, a mining town, and Parrot Island, an island where the parrots come to roost for the night. It was a low key Old Year’s celebration with only two other couples at the resort, but it featured delicious food, free rum punch and fireworks/steel wool at midnight to ring in the New Year.

My family learned of wonderful phrases like “liming” and “just now”, fell in love with cherry juice and expressed a never ending curiosity about piles of white sand found on the street. I’ve got permission to drive their vehicle anywhere I want after touring them around Georgetown which is a bonus, considering for a little while they weren't going to let me drive them around in Guyana. All in all, it was an unforgettable family holiday and has made the time until I am home again feel a bit closer.