Christmas Around the World

Christmas Day finds my family on three different continents, what's new? We're in Barcelona, the sun is shining and the sky bright blue over the Mediterranean Sea. Our Christmas dinner will likely consist of tapas instead of turkey. My older sister is in the midst of an Australian summer while the younger one is on a local boat somewhere on the Amazon between Pucalpa and Iquitos in Peru, a few cows are penned on the boat deck and apparently there was potential for one of the chickens to turn into Christmas Eve dinner! Mom and dad are staying in Calgary this Christmas, celebrating with old friends while my in-laws are having a feast in a brown and snowless Manitoba...what a family it is!

Of course, Christmas in much of the world is very different than the shimmering lights, Christmas markets and designer boots we find ourselves surrounded by here in Spain. I love the public health messaging campaign below about the 'festive season'. The gift of health for Christmas is priceless but as 'cheap' as two doses of antimalarials for some!



Wishing you all the best of Christmases, may you know hope and peace, and share some of it around.

Tanzanian Nostalgia

I recently went on a rather nostalgic trip to Tanzania to climb Kilimanjaro (an epic tale told elsewhere). Let me be clear, it wasn’t nostalgic because I’d climbed the mountain so many times before! The truth is, I really like Uganda. It’s a country with a dark and violent past where (for the most part) people have chosen reconciliation over judgment and much about the nation and its people fascinate me. But I LOVE Tanzania, perhaps because I speak the language, I can interact on a different level, joking and teasing. Undoubtedly it is because I spend a very formative year of my life there. Immersed in Tanzanian food, culture, language and families. I will forever think their elephants are larger, their hearts are bigger and their language more beautiful. There’s no questions I’ve left a chunk of my heart there. The nuances of Ugandan work culture and language are to some extent wasted on me. Tanzania was my first African love, I can’t help it!

I miss Tz.

Cervical Cancer History

As we wind our way deeper into Kisenyi II past the pungent aroma of fermenting millet, down a steep alley, through a door that opens onto a dirt courtyard of children playing and women washing clothes, around the corner of a block of latrines you can see how a child could get washed away in a downpour. We edge along narrow ledges between houses, the drop-off off to deep open sewers inches from my toes. I duck my head to follow Veronica into a house, a sheer piece of cloth is the door. We are welcomed and a colouful woven mat is layed on the floor where I sit, legs bend beneath me next to Hadija, a wide-eyed 2-year old chewing on her breakfast chapatti. The morning sun glows through the curtain as Veronica explains what we're doing and asks if the woman would like to participate. She's keen to get tested only after she is reassured that she won't have to 'open her legs for an exam like they do at the hospital' unless the test is positive.

Although I am obviously deeply invested in the project and passionate about working towards preventing women dying of something so incredibly preventable it still boggles my mind that women are so open to collecting their own samples and being screened for HPV. On our first day of testing, one of the teachers at the primary school heard we were testing for cervical cancer and ran over to find us during recess so she could get tested. They take the swabs, go behind a curtain or to the latrine, and come back with the specimens for the research assistants to label then ferry to the lab for analysis. To be honest, if someone showed up at my door with a cooler full of swabs and asked if I wanted 'do-it-yourself' cervical cancer screening I might just shut the door. Although the logistics of a truly community-based screening program can seem intimidating, I can't help but be encouraged by how eager women are to be involved.

I remember an impassioned speech by Stephen Lewis at a huge HPV conference in Montreal last year. His usual topic is HIV but he spoke about cervical cancer that night, and the tragedy of something that is completely preventable, not only with screening, but with an effective and safe vaccine that is responsible for the death hundreds of thousands of women across the world. Over 85% of those deaths occur in the developing world where there is no infrastructure for effective screening programs.

I heard Stephen Lewis again more recently, on a CBC podcast interrupted by haltering internet when he spoke at the funeral of Jack Layton, previous leader of the opposition. The quote of Jack Layton's that stuck with me was 'Always have a dream that's longer than your lifetime'. Today, my dream is to make cervical cancer a historic disease, this disease that is often called a case study in health equity has no right to take the lives of young women, regardless of where they are on the planet. Check in with me in a decade to see how we're doing.

Blatantly Obvious

The sound of my feet pounding the path was the only rhythm I was aware of as I slowly climbed the incline of the Kololo hills in the rising early morning mist, past embassies and houses that would put the mansions of Shawnessey in Vancouver to shame. As I pass Kololo Heights and start my descent back home, the orange ball of the sun peaks out from behind Ntinda hill sending sunbeams shooting through the low lying clouds in a brilliant peachy fan. Running is good for the soul. A nearby mosque emanates sing-song prayers out into the waking world. Funny, I think to myself, normally their morning prayers are done by this time.

As I drink my coffee, the plan for the day goes through my head, meeting with PATH (an NGO with offices nearby at the WHO building). Then Michael (Doreen’s replacement) and I had a long to do list, check-out labs for processing cervical biopsies, buying a specimen carrier, editing and printing surveys and educational material, we had discussed it all just yesterday.

I show up at the gate of the WHO offices at the appointed time, but have an intriguing discussion with the guards at the gate. No, no one is in the office today. Why? They give me a strange look, a bit confused even. Well, its Eid.

Of course, Eid, silly me, oh well. Having not learnt my lesson I tromp down the hill to Mulago Hospital, get to the office to find the place a bit deserted. That’s funny, Mike and I had this work plan, oh well. When I call him (he’s a good Catholic boy by the way), he says: Sheona, it is Eid, we cannot work today!

I now recalled our scheduling challenges with the outreach workers in Kisenyi:

Does Monday work? No, Veronica’s church has to help distribute the World Food Program food.
Tuesday? Well, Esther is a Muslim, it could be Eid.
Wednesday? Well, it could be Eid.

Of course no one had thought to tell me, its obvious to the rest of the world, the date of the huge celebrations of Eid marking the end of Ramadan can’t be announced until the Imam sights the new moon.

It reminded my of a lovely family from Kerala, India who after recently moving to Calgary experienced their first Halloween. Of course, no one had thought to mention to them that children in their neighbourhood would be coming by, ringing the doorbell, yelling ‘trick or treat’ and asking for candy. Its so obvious, isn’t it?

So I spent the day immersed in epidemiology and statistics, catching up on courses instead. I have to say, I was grateful for Eid!

Debt Perspective

From The East African Newspaper August 15-21, 2011

Kampala Calling

After an unplanned, frustratingly exhausting 30 hour tour of Africa courtesy of Egypt Air which included such notorious airports as Cairo, Dar es Salaam, Kilimanjaro and yes, eventually Entebbe I am now back in Uganda! I had the most surreal experience during my 5 hour tour of the Dar es Salaam airport. Having come through Madrid in Europe, many of my fellow diverted continent-touring comrades were from Spain. So when we were grumbling and groaning about our predicament, naturally, I spoke Spanish, however, when we were given our breakfast coupons (yeah for chips and chicken as the only option for breakfast at 5am!) I ended up sitting with a lovely Tanzanian bloke who works as a lawyer at the Arusha Human Rights Tribunal who had also come from Madrid, so naturally, I switched to Kiswahili….much to the confusion of my newly acquired buddies from Barcelona who hadn’t been able to place my Spanish accent to start with. Surreal. I was post-call equivalent as it was which probably heightened the dream-like nature of the event.

I got to the guesthouse from the airport at 3pm, showered and dropped by the office to check in with our research program assistant. Our to do list was long and I just wanted to pop by, say hi and outline our plan of attack. I found not the woman I had seen in January, no, alas, there was a very very pregnant woman sitting at the desk….very. The baby squirmed visibly across the tautness of her belly beneath her clothes. Although she was expecting me, she looked rather….well, sheepish I suppose. My mzungu self blew up inside of me, why on EARTH would this not be something you would mention to the research program so they could make some adjustments?! But FORTUNATELY, the lovely culturally sensitive, accepting inner being took over, congratulated her exhuberantly and enveloped her sheepishness in a hug. I need to zen out and get with the African way of doing things. When I asked how the pregnancy was going she said “Sheona, why do I feel these contractions every 20 minutes, I don’t understand?” She’s due in three days…life happens, awesome, complicated, real.

As I sit writing this the clatter of the monkeys scurrying mischievously across the tin roof startles me occasionally. I’m staying at the Mulago Hospital guesthouse for a few days before moving into my apartment. The guesthouse consists of two, not quite rustic, not quite luxurious house-like structures set on the slope of Mulago hill surrounded by deep green grass scattered with brilliant purple jacaranda blossoms fallen from the trees and the occasional sharply textured globular Jack fruit, cracked and oozing its sweet white nectar onto the surrounding celebrating ants. In addition to the resident monkeys there are a few large Ibis who wander, searching for bugs in the grass with their long smooth beaks. I’m exhausted, overwhelmed by both the logistics of research and the epi and stats MPH courses that I’m starting. But I’m also overwhelmed by gratefulness, for the opportunity to be here, the thrill of the daily realities of life in Uganda and excitement for the next phase of the project. Life is crazy, but good.

MIA for a Year

There was an intense yet fascinating two week at Hopkins. I’m taking a part-time Master’s of Public Health that will allow me to spend the majority of the year between Uganda and Ecuador working on a cervical cancer research project. The John Hopkins School of Public Health turned 95 years old this year. A world-revered institution that churns out research at an incredible rate and who’s motto is (seriously folks) “promoting health, saving lives….millions at a time.” I can’t take them seriously. The Hopkins medical center is a state of the art institute of modern medicine situated splat in the middle of a ghetto. They shuttle us back and forth from the residence to the medical campus for safety reasons. Looking out the smudged window of the bus I see row after row of brick houses with boarded windows. Is it not a deep irony that this desperately poor and crime ridden community, somewhat of a public health disaster, surrounds one of the world’s leading school’s of public health? With disproportionately high rates of HIV in the African American population that lives there and statistics that show if you are an African American man you will die 30 years before your Caucasian counterpart it makes me suspicious of the program I’ve just signed on for.

Regardless of all the irony and healthy ego of the institution, I am awed by my classmates. I become quick friends with Sara, a young soft-spoken Southeast Asian pediatric ICU physician from Stanford who loves climbing and road biking and has set up a peds ICU in Kathmandu. One of my small group members was an adviser on the Bush administration’s bioethics committee, needless to say he had to find a new job when Obama came in and is now a health policy analyst at the NIH (National Institute for Health). The list goes on, but I quickly learn that those who surround me are without a doubt the biggest resource I have.

I returned to Vancouver for a frantic two weeks of baby catching which completed the requirements for my Baby Mill Chief rotation! Although unlike gyne oncology, it was far from passing with flying colours, I met expectations. I’ll take that and run. I pray that I never eat my words in the future but if I EVER sign up to work at the Baby Mill when I’m done residency someone please slap me, churning out babies at that pace isn’t good for my soul. July 1st was my last day of call at the Mill. A few of my favourite nurses took me out on the weekend and said the loveliest of things about how much they liked working with me, they can’t possibly have any idea how much it meant to hear that.

And now for a year that will beat to a different drum, I won’t hear the rhythmic thumping of the fetal heart Doppler, the reassuring snapping of sterile gloves on my hands or the smoothness of a scalpel sliding through skin. I’m excited, ungrounded and apprehensive all at once. Uganda, Ecuador, Egypt, Spain…oh yeah, and Baltimore, here I come.