Time really passes fast here. It is hard to believe that I only have 4 weeks left! I feel lucky that I have had the opportunity to do both clinical and public health work as this work has kept me very busy and has provided for some very different experiences. Things have been extremely busy and I just took a long overdue day off yesterday. I spent most of the day in Lambarene, walking around the market and just watching (African) life go by. I think it was just what I needed.

There have been some bumps in the road regarding the health education training program. Last week, the director / moderator of the training decided that she would no longer participate. The real unfortunate thing is that she didn’t tell me until the night before she was to give the presentation on family planning. I ended up working through the night and put together the presentation myself and then gave the presentation. I broke the talk up into two 50 min long presentations and I learned that it is exhausting to speak in French for 2 hours straight. For some reason I had difficulty pronouncing one of the technical words in French. I tried about 5-6 times to get the correct pronunciation much to the amusement of the group. When I finally got it right, I got a standing ovation. It really made me smile.

In the end I think everything went well and we have had some excellent discussions. So far we have covered malnutrition and family planning. I think the highlight of the training sessions are the case studies/ role playing exercises. The nurses and midwives that I am working with are quite talented. They are so incredibly animated and I have been impressed with their creativity.

There is some concern in my eyes about the sustainability of this program now that our leader has stepped down. I am in the process of talking to an epidemiologist that works with the Ministry of Health in Lambarene. She has expressed interest in helping out with the training so I am hopeful that she can replace our previous moderator. In addition, I am working with "Mamma SIDA" a local woman who organizes community health education session on HIV prevention. She has a strong presence, is knowledgeable and has a booming voice. She is scheduled to present the HIV talk next Monday and I am hopeful that she will continue to assist with future health sessions.

Ultimately the goal is to have someone continue to lead these health education sessions on a monthly basis. We can eventually expand the training to include the nursing assistants that work in the rural health posts throughout the region.

In other news, the health illustrations that the artists have created are incredible. I am extremely pleased with their work. The two artists that I am working with are very motivated and talented. The illustrations really capture the important points concerning the selected health topics. We are hoping to have the illustrations for 4 of the 6 subjects completed by the end of next week.

We will be able to use the Malaria education illustrations for this week's presentation. I will eventually scan all of the images onto my computer before my departure on March 14th. I then plan to have the illustrations enlarged and printed in a flip chart format. After looking into prices here in Gabon, I think it will be less expensive to do the printing in the US. Future Schweitzer Fellows and other staff can hand deliver the charts once they are completed.

The pediatric work continues to be a highlight of my time here. I really look forward to the trips out to the villages. Not only is the clinical work exciting and challenging but traveling out to the villages provides for a rich cultural experience. Recently there seems to be an increase in malaria cases. After speaking with the malaria research center here I think that can mainly be attributed to the seasonal rains. It really can be challenging working in
the rural villages without any lab/ diagnostic tests to support a diagnosis. On one hand, it is challenging to make the diagnoses without the myriad of tests that we have at our finger tips back at home but on the other I truly feel that my clinical skills have been tested and as a result have improved significantly. You really only have the patient history, a stethoscope, otoscope / opthalmoscope and your brain to rely on. I have medical reference books that have also provided some useful information.

Over the past few weeks, some of the cases I have seen include malaria, upper and lower respiratory infections, shingles, buruli ulcers, gastrointestinal infections, fungal skin infections, malnutrition, dehydration and conjunctivitis. Some of the children are very sick when they arrive at the health clinics. The health team can help transport the very sick to the hospital with their truck and over the past 2 weeks we have brought back 5 children (2 with cerebral malaria and the other 3 extremely dehydrated and malnourished/ failure to thrive).

Thanks again for following the blog. I will continue to post photos as often as possible.

Here are a few more random photos I thought I would share......a cobra, killed about 20 yards from my house.

Dinner out on the town: