Mission to the World / ACT HIV Program

http://www.mtwact.org/mtwact.org/Work.html

This will be my last post from Addis, but I do plan on posting more pictures and some stories when I get home, where the internet is something I can lovingly take for granted. We have spent two weeks doing some amazing things, and so much of it would not have been possible, or at the very least would have been so much more difficult, without the generosity of all of you—but also of Bekah and Jonathan Dhillon, who are living and working here with their two young children for a year. Keep them in your prayers as they round out their year here in Addis.

Yesterday was spent with the HIV and TB project where Bekah and Jonathan work. I had an amazing day talking about HIV care here in Ethiopia and HIV care in the US. It was great to be able to share research results with them on some of the projects I jave worked on for the last 10 years through IMPAACT and PHACS. I was able to talk about our HOPE program, and they talked about the issue of women continuing to have babies after diagnosis. The thought initially was to counsel them to have no more children—kind of like what we were doing not that many years ago in the US. They found that no matter what type of counseling they gave them they still kept having kids. So we talked about the HOPE program and how a counseling program for healthy pregnancies is something that they could possibly entertain. It’s hard when many time the pregnancies might not be planned by the women and may be a product of "coercion". So, again empowering women with as much information as possible may be a better way to move forward, and they were discussing just that.

In the afternoon I was able to see several of their HIV + children. This was so interesting and so much fun for me. I loved seeing kids with HIV and talking about their health histories and their medications and providing some education to the health care providers, as well as to the families when I could. I also really was able to learn so much about how the care of kids with HIV in the community differs from the care provided in an orphanage setting, and also about their similarities. Again, the same old problems with adherence are universal when the kids hit adolescence. One thing that’s clear is that some of the kids who were not yet on HIV medications probably should be, and we would likely see some great growth and better overall health if they were. This project was willing to fund more viral loads for the kids, and we talked about when a viral load might help. I shared some case studies of the many kids who come home from Ethiopia with that dreaded K103 mutation-making, non-nucleoside analogue—a poor choice in the long run. They all agreed it was due to the Nevirapine used in PMTCT (Prevention of Mother To Child Transmission). It was one of my favorite days in Ethiopia, just being with Beakh doing the home visits and seeing patients in the afternoon and just getting to talk about HIV care and ways to improve it.

Today I visited an another orphanage, Kidane Mehret, and that was an awesome experience which I will share with you all when I get home. All the orphanages (care centers) I visited were so different—they all had similar challenges—but the overall feel and they way they handled things were unique.. Thanks again to all of you for following me and supporting me. More pictures and stories to follow.

Love,

Emily

AHOPE

I had a wonderful time visiting AHOPE, http://www.ahopeforchildren.org/index2.html. I can say that much has changed in the last 5 years- and yet there is, as one can imagine, always room for more improvement. The younger kids are at "Little AHOPE," which is, interestingly enough, at the "Old CWA" care center. I recognize it from photos (it is not where my children were kept when we were not allowed to see them in the care center). It is much nicer than the old little AHOPE. We met with the nurses and the director for quite some time. I presented some interesting case studies of kids who had come home and things we have learned and what we provide them as far as health care, counseling referrals, etc. when they come home. They had excellent questions and we really had a great discussion. The nurses asked great questions about resistance and adherence and child development. They have many new programs in the last 5 years. I will try and describe them here the best I can:

Little AHOPE is for double orphans from birth through about age 8. There are more boys than girls—this is unexplainable. It is not due to adoption of girls over boys—it is just that more boys come in than girls. It could be families keep the girls to work, or perhaps the girls are not tested? I think in the older portion of this younger group there may only be 6 girls. They were all in the little dining room and it was stark how obvious it was that the boys outnumbered the girls. The babies were all in a small room and sitting in bumbo chairs (http://www.amazon.com/Bumbo-402-Baby-Seat-Blue/dp/B0007ORN7M) and seemed to be happy and well cared for. Pudgy little folks. I was able to interact with a child who will be coming home to a family in Denver—hopefully soon. A nurse gives meds at 6:00 pm before dinner. The kids line up alphabetically and are given the meds—they do not fight it and it goes smoothly. I shared my concern that filling a belly with lots of liquid antiretrovirals may make a child lose his appetite for dinner or breakfast.

Big AHOPE is for kids about 8+ to about 16. The thing is there is no more room at big AHOPE so as this occurs more of the 8 and 9 years olds are staying at little AHOPE. Big AHOPE is also for double orphans and they get all of their care and meds there. They go out to their different schools. They no longer are schooled onsite. This is an improvement. They have a new "Dean,” a nice fellow who gave us the tour. He is working on developing life skills, and creating a more stable, constant environment for these kids (45 kids—only 15 girls). He lives on campus and his room is right next to the boys’ dorms. These rooms are small and somewhat crowded—though better than some orphanages (and worse than others). He is there 24 hours a day. He is kind of “on watch” at night as well. His words: "very important tobe here at night." Kids get their meds by the same nurses as at Little AHOPE—but at 7:00 pm, after dinner. They give the nurses a very hard time, and they are finding the same issues with adherence in this adolescent community that we do in the states. We spent quite a bit of time on adherence education.

Over the past few years, they have had some kids who have had some family members come forward, and those kids have gone home. They have become part of a community project. They found this was not as successful as hoped with just a single monthly home visit, and so they now visit them twice per month in their communities, and the families come once to AHOPE per month—so 3 times a month they check in. They provide a meal package for the child, although it is often eaten by the whole extended family, and the child ends up with adherence issues. Therefore, they decided they needed a new program, so they started The Child Development Center.

The Child Development Center is a place where kids who live close enough come every day, 7 days a week, from morning to night. They gets meals, school fees, medical help and psychosocial support from AHOPE. This program has been very successful—they quite literally have a van which goes around and picks up all the children. If they live too far, they are part of that previous program I just mentioned. I have the numbers written down but my memory is that this serves about 75 children. They are very proud of the success of this program. And I was impressed by how well they are meeting the needs of children with HIV so they can stay in their families. Many of the kids attend the WWO school and also other local schools.

The newest program, which is not yet implemented, but it sounded like it was soon to be implemented, is a transition program for the older youth. The children who are about ages 13- 16 will be moved into condominiums in the community. It’s modeled after the SOS Program. http://www.sos-usa.org/About-SOS/Pages/default.aspx. The SOS program is a family centered program for orphans. The director, Sidesse, is very excited about this because her hope is that these kids, who will not likely be adopted out of AHOPE, will learn life skills and spend their adolescence in more of a family environment. There will be one person who will work 6 out of 7 days a week living with the kids and tending to them, caring for them and teaching them. They will be in small groups of about 6-8 kids.

They chose 13 as the cut-off age because there is this slow-down with adoptions (which many of you know about )and with that slow-down it will be almost impossible for a child 14 and older to be adopted by the time they are 16 (which is the legal age limit of adoption in Ethiopia). I asked if they were bringing these concerns to Ministry of Women’s Affairs (MOWA), and they are. There have been many discussions about how many of the oldest children will “age out” before being adopted, unless they are identified by 13, or 14 at the latest. These kids in the transition homes can still be adopted—they will still show up on a list of waiting kids—but they are going to be very careful not to plan for an adoption because it’s so unlikely. So, the kids will not have any unrealistic hopes for families who may never come. But, if a family does want to adopt one of the older kids, they can still do that. This program has not yet begun and has its obvious merits—a place to learn to cook, clean up after yourself, give your own meds, take charge of your own health care, and to function in a smaller "family" like setting. But as with any new program there will surely be challenges along the way. I also would imagine that for those kids moving out of AHOPE—the only place many of them even remember—this could be a bit frightening. But surely it’s better than suddenly turning 18 and finding yourself on the street all alone!

Of note, the new Dean of Big AHOPE has also made some big changes in the last month. The kids now have to clean their own rooms and make their own beds and help clean up after meals. This was something they had never done before, and he has met with considerable backlash. But a month into it, he is finding it very successful and has even identified some leaders among the kids who really have matured and have taken on extra responsibility. He was very proud of this.

Finally, I have many pictures of the kids which I cannot post. I want to thank the 2nd graders and kindergarteners at Westerly Creek who donated so many band-aids and supplies to AHOPE and the other orphan projects I have visited. I also want to add that if you are adopting a child who is waiting for you at AHOPE—please email me as I might very well have a photograph of your child. I took quite a few, and a few short movies as well. God bless all of you who are adopting a child from AHOPE or any of the other agencies here in ET. I know the wait must seem unbearable, and having been here and seen the kids, I really feel for you and for the kiddos.

Hypothetical Michael

This post is not from Emily or Michael. It is from Michael's brothers and sisters left behind in the U.S., who have been looking at pictures of Michael in Ethiopia, and noticing how excited and pleased he seems in every one, and who are beginning to worry just a little bit that he won't come back, and if that happened, how terribly they would miss him. In fact, they already miss him, and because things don't seem quite right around the supper table, they created a temporary stand-in, whom they have dubbed 'Hypothetical Michael.'

I wasn't there during the creation of HyM, so I can't really speak to the strange fact that his "face" has a picture of both Michael and his younger brother. However--and this is pure speculation on my part--it might have had something to do with Yabsera being jealous that Michael's face was being stuck to a soccer ball and not his.

Anyway, this is what his sibling stare at, longingly, during breakfast, lunch and supper.

Come home soon, Michael Michael Motorcycle!

Visiting the Fistula Hospital in Addis

This morning we visited the Fistula Hospital (http://www.hamlinfistula.org/). This is the same one from “A Walk to Beautiful” (http://www.walktobeautiful.com/; http://www.pbs.org/wgbh/nova/beautiful/) and the one Oprah Winfrey has supported (http://www.oprah.com/spirit/Inside-the-Fistula-Hospital_1). I can honestly say it’s one of the most impressive organizations I have ever seen. It is so comprehensive it’s amazing. They support women who have developed fistulas from birth and other traumatic experiences. All of their care costs nothing to these women—they come from all over Ethiopia after being shunned by there communities and their families, often after having lived in small huts, alone, due to the odor because of the incontinence. They develop foot drop and contractures from lying in curled up positions on dirt floors for months or years. They are malnourished due to the fact that they eat and drink very little because of the incontinence.

They come here and they are given nourishment, physical therapy, surgery, post-operative care, and education. They learn to make handicrafts, which are then sold and the profits go back to the women. And one of the most important things is they receive counseling and education about their condition. The emotional toll of losing a baby after 5 days of horrible labor and then the months or years of pain and discrimination takes a great emotional toll on these women—many who are very young, but really they are all ages. The woman I spoke with said the emotional counseling is often more important than the physical therapy.

The PT room had the birthing balls and exercise bike and heat lamps for contractures. It was amazing, and they had ‘before and after’ photos of women which would just blow your mind.

We saw the post-operative ward and the pre-operative ward. The other incredible aspect of the hospital is that they only require two things of these women in return for the weeks or months of care (it’s different for everyone, but the average stay is 34 days). First, is that they go back to their village (they provide the transportation) and tell everyone they know about this place because usually the referrals come from the women who got care. Second, is that when they become pregnant they must return by the time they are 6 months along. They will get nutrition and care and education and will deliver their baby by C-section at a hospital here in Addis so they do not damage their repairs. We also saw the maternity ward, where there were pregnant women and women with young newborns as well.

They also have a midwifery school, and this is on another campus where some of the women whose repairs were not fully successful live and work a trade and run a cafe. We may visit there later this week. Midwives require 4 years of training, and through this institute it is free if they are willing to work in a rural area for 2 years after graduation. They have 4 satellite centers in various regions of Ethiopia.

The hospital has a 95% success rate, and the other 5% are able to stay and live on that satellite campus. Those women may have ongoing ostomy care needs (http://www.ostomy.org/ostomy_info/whatis.shtml) that would be difficult to provide in a rural village.

The school room, counseling offices, and various wards were all so impressive, and all of the women were so well cared for and it really warmed my heart to see how one couple could reach out to a group of some of the most marginalized populations in the world and TRULY make a profound difference in their lives.

We will also be visiting AHOPE later today. I look forward tp sharing about that trip soon.

Love, Emily

What A Day We Had

Again on someone's laptop which costs them money and so I can’t type as nearly as much as i would like So, very briefly—what a day we had!

One thing I neglected to mention in my last message was that we were NOT able to meet Michael's brother. That was a shame, because we came all that way, and if we had one more day, and a little more stamina, we might have been able to make it happen. But we just couldn’t swing it.

Today was so precious. Our first visit was to family who are cousins of Yabsera—but really the direct relatives of the Daubenmeir’s little girl: her father, her family. We were there a long time, so I have many photos and stories for them. I spent the day with Fitsum’s father (handsome guy—and with two daughters and a son, younger than Fitsum . . . all so beautiful).

Then we went to Yabsera's home. When we walked into the home of his grandmother, they all started chirping, "Lululululululu" . . . kind of a high—pitched song of excitement. I can report that his Ethiopian family is "so Yabsera.” His grandma kept kissing me and was so sweet and looked just like him. Not kidding. His grandfather has passed away (I just realized I never asked what his name was). But wait till you see her—so sweet, so amazed at seeing his pictures. I also met his uncles and some aunts.

Mulu (Yabsera’s first mother) recently moved to Khartoum, only about two weeks ago. I just missed her, which made me very sad, and when I heard the news my heart sank a bit. But then we were outside the round mud home taking some pictures and I was getting "Mulu's family" together and they pulled this little boy into the picture and I said, “who is he?” And they said, “he is Mulu's son.” So, yes, I met Yabsera's brother! Mulu’s first son. He is just a little older. They first said he was 6 and later said 10. He can’t be much taller than Yabsera . . . very handsome and very shy. I did get him to smile and showed him pictures of his younger brother, and I have photos of Michael with him. So, a little surprise that apparently Tshay didn’t even know about. I asked what he was like and they said, "he likes football, riding a bike (never saw a bike in Sodo, so not sure if the interpretation was right) and he likes to eat food and drink milk. Sound familiar? Before we headed back, they all sang for us and I can’t wait for Yabsera to hear and watch this—he would have joined right in singing and dancing.

When we got back to Sodo, we went to a home-visit and saw the baby, Tamrat (from the Miracle Baby series on Sophie’s blog that I link to in one of my early posts on my blog). The experience was just amazing, and I can’t wait to write more about what they do here at the hospital and in the clinic. It’s very exciting and quite amazing and frankly hard to even believe. This baby should not be alive but is thriving and I will show you pictures.

So Michael has had a few days of full exposure, up close and personal, to what his life might have been like. On the way home, we bought mangos and bananas. He was eating a mango (his 3rd) and he just said, "I am so lucky." I said, "because you have a mango?" And he said, “yes, I am lucky for three things: that I have this mango, then the 2nd reason is because I was adopted, and the 3rd reason is because I have you and daddy." I think all of what might have been sunk in. I was quick to tell him that in fact Mark and I were lucky, and he asked why and I said, “because we have you and Yabsera and that makes us so incredibly lucky.” (We also like Maddie, Cal and Phoebe, so blessed all around!) But I do feel so lucky for these boys that we brought home 5 years ago. Michael has been so good with so many hugs and kisses from strangers, and just having to be hot and be around a lot of flies and be really, really patient.

We leave for Addis in the morning. I will see a bit more of the hospital here and then in Addis I have some orphanages yet to visit and may visit again with Dr. Sophie if I can. It has been so interesting to learn about HIV care here in Sodo and I look forward to sharing all about that with my friends at CHIP and HIV To Home.

Michael and I miss you all.

Love,

Emily

Our Family in Wolaita Sodo

Typing from a cafe at the hotel in Sodo on Sophie’s little laptop. I won’t be able to type long, however. In short: we arrived Thursday and met with Dr. Ruth, Sophie and Dr. Stephanie. Just hung out for a bit and gave them many donations which they were very, very excited about.

On Friday we set out in the AM and I was kind of on a mission to connect with the woman we knew about who was related to Mulu—Yabsera's birthmom. We had some phone numbers, and I’ll write the whole, long story later, but at one point we were at this bank where Ruth told us to go which was supposed to have a cafe but did not (turns out the new Dashan bank has no cafe). At that point we called the man who was the father of the Daubenmeier’s kids and he answered and came down. He took us to see this woman at Tsheay's house, and we went there. This is the home where Yabsera was born. This made Michael a bit jealous—because he would like to see the home where he was born.

This woman was very gracious: she gave us shiro and injera and Fanta and coffee with milk. She was happy to see the photos of Fitsum Grace. We all talked a lot—well they all talked a lot and I just tried to listen. So, at some point she said, "I have a photo of Mulu." I was like 'Ummmm . . . can you please show me?” I was trying to contain my excitement. She pulls out a huge album and a photo of not just Mulu . . . but of baby Yabsera, too . . . and, yes, it was so clearly Yabsera . . . his eyes . . . his big ears and the extra little dangling finger. He is maybe 3-4 months in the picture? But so cute, and his mom is beautiful and tall! I can’t wait to show you. I took pictures of this and many other pictures on my camera (many for Fitsum). There was also another photo . . . a baby from many years ago . . . he looked so much like Yabsera that Michael actually said "that’s Yabsera!" However, it was actually the daughter of Teshay. I have a photo of her all grown up. Tomorrow we will actually go and visit with Mulu's parents (Yabsera’s grandparents). His grandfather is a church elder and Mulu sang in the choir (of course!). So excited.

I have so much more to write than I probably have time for. I may get a chance later to write more. Michael has been so excited, and yes, in my exhaustion I have had to say things like, "I know how excited you are, honey, but you have to realize how exhausted I am and please just be quiet for a bit," and he does, God bless him!

We left with Kebede and Dr. Stephanie and went to the market which was so much fun—and a bit scary. We bought fruit and veggies and lentils and a chicken! Michael picked out the chicken, and was very concerned on the bumpy road to his grandfather’s about the chicken’s well being, saying "Ummmm, you know we have a chicken in here right?" as we bumped along. There are many details which I will skip for now, due to time, but Ato Ashango was so happy—when he saw Michael he could hardly contain his joy, and scooped him up, saying, "Maren! Oh Maren!" We were mobbed . . . many people kissing and grabbing Michael. I was admittedly very nervous that Michael was going to freak out, but he handled it all with such grace.

I have so much more to tell, but for now I’ll just tell this story. Later in the day, towards the end we realized there was a cow in Michael’s home and so he wanted to see it so we went into the house and while in there we heard they had just lost their beloved cow . . . yes, this was “Maren’s favorite cow" which we heard about from Heidi, and that we have a photo of. And then someone taps on my shoulder and they gesture down and sure enough there is the hide of "Maren’s favorite cow" spread out on the floor. Stephanie and I could NOT stop laughing . . . I can’t tell you how funny it was . . . for us . . . but not for Michael—this was his favorite cow after all!

One last sweet thing before I have to go—they all told him he looks just like his father. And his mother looked like Ashango. Last night, Michael drew a few pictures of his Ethiopian parents—wanting so badly for the photo that Yabsera now will have and he never will.

I gotta run. Much love to everybody.

Sister's Of Charity

I do not have much time to write because in a few minutes Michael and I will be heading to Sodo to see Dr. Ruth and Sophie and to see his birth family. This is the same drive we took about 8 years ago in search of some answers and to see where M and Y came from. We have been looking forward to this all week. Yesterday we spent with the Sisters of Charity which was a long and rough road out towards the far reaches of north west Addis. In the car was an NP who is here studying some natural pathic remedies and an Ethiopian Pediatrician who does a lot of teaching on HIV in the outskirts of Addis, Bekah, the nurse I am staying with who is working on a TB/HIV project. There used to be a nun who gave the kids a mixture of Aloe and Honey before ARVs were available and she swore by its ability to slow the progression of HIV. That nun is no longer there- but the ghost of the once lively Aloe field shadows over the new clinic where they will only give ARVs and do not believe in alternative or complimentary therapies. The complex where these kids live is absolutely beautiful. They grow their own food. Have a state of the art school on the compound where all 361 kids with HIV who live in the orphanage attend along with uninfected children from the community. Early on they tried to send the kids out to schools which created a stigma- clearly someone very smart and very wealthy said- "hey if we build the best school you can find in Ethiopia - those kids will WANT to come to school here no matter what." and it worked- not kidding the school might as well be DSST its so nice.

The clinic is also state of the art and they have started caring for women ad children from the community. Most of the cases were TB cases. On 16 year old who looked about 5 at the most- no body fat who had horrible disseminated TB. She was left to die for a year before her father brought her in. When she whispered that she was 16 my heart sunk. A baby with congenital cataracts which looked possibly like something secondary in my inexperienced opinion who was waiting to get fat so she could have surgery. She kept kicking her leg as if to say "Would one of you people please do your job and pick me up!" She was darling and as we got close- she knew- because she beamed at us with a toothy grin.

The orphanage itself has a few dorms, some nice play grounds, soccer field and basketball fields. The actual dorms are packed with bunk bends flush to one another. So a long room with 15 bunks right next to each other along each wall- 60 kids in that room...then the next room the same...the next room the same...it never seemed to end. It was meticulous. The laundry system was amazing, the dining halls were all clean, the kids uniforms were like brand new, the kids seemed happy and playing as they left school. It appears that they have taken a horrible situation of having too many HIV+ children without parents and have built the best physical complex they could. But I couldn't help but think as I saw the rows of bed and rows of table that there cannot possibly enough adults in these kids lives to provide them with the love they will need to really make it in the world. All the HIV medicines in the world just wont do the trick if you don't have someone who loves you enough to see you through the tough times and to laugh with you during the good times.

In some was- even though it was beautiful- like the best summer camp you can imagine...it really made me feel sad...because these kids will not get on a bus in August and find a mom and dad and big sister and Brother waiting to pick them up and take them home. They are doing the best they can with what they have. My advise would be to break up those big rooms into smaller family unites with consistent caregivers. They have the land and ability to do this. They have a transition house for the 18 years olds and so far it has not been successful...as you can imagine...but if they started early with a family unit- and those kids grew like family they could all transition together. Better yet- these kids need real families. So I would look into which agencies have started pairing with this agency and go from there- if you are ever so inclined to adopt a child living with HIV that is.

Children's Heaven

I have so many wonderful photos from visiting the girls at Children's Heaven. I can't wait to share them. One of the organizations I am involved in, Ethiopian Orphan Relief, helps support Hanna Fanta and Children's Heaven. You can read a little bit More about them if you go to my previous blog post. They are renting a new facility and it was wonderful to see in person. they have a large area which has a canopy to keep the sun and rain out where they do aerobics and general teaching and play games like basketball. There is a tent (kind of like an army tent) where the girls eat meals and a nice indoor space for teaching and gathering. The purpose of Children's Heaven is to provide a place for girls from age 8-18 to come after school and on Saturdays. If they attend school close by they come for their lunch. If their school is father away- lunch is brought to them. For many of the girls this is their only meal of the day. They provide the uniforms and books needed to attend and stay in school. They provide tutors and scheduled activities. For instance on a Saturday they arrive and are fed breakfast. They then do aerobics, play games, help with certain crafts and some health programs used in the community. They eat lunch and then some are part of a soccer or basketball program. And certain girls are part of a program where they are able to shower and bath and do each other's hair for the week. These girls often have an HIV+ mother or their mother has passed away and they are being cared for by an Auntie or grandma. They are at HIGH risk for ending up on the street, ending up pregnant at a young age, dropping out of school...you name it. Hanna's goal is to help each girl succeed at what they want- and I can tell you after the introductions 9 out of 10 of them want to be a doctor. I believe that many of them will go on to do wonderful things because they have this one woman in their lives who just believes in them, loves them, cares about them, feeds them and tells them that they are important.

Hanna used to live and work in the US. She worked for the United Nations. Later for a bank...one day when her children were grown she felt called to return to Ethiopia to help one girl. Her goal was to help just one young girl. She was sharing this story with us while sitting in front of about 75 girls...it was one of those amazing stories where you know God has a hand in her life. He new goal? 100 girls by 2013. She is at 81 now.

You can imagine the tragedy that each child sitting there has suffered. Not one of them is spared. I asked Hanna what kinds of needs they have and she said "A Counselor" as the girls are aging up they have more and more need for counseling and therapy. She has had girls loose their moms, one girl even took her own life not long ago, and there have been a few pregnancies. It is the ugly stuff that is hard to share - because you want to share the beautiful smiles on these girls faces and the joy they have when singing to us- but it would not be truth if you did not understand why there is even a need for Children's Heaven. We talked about sex education. They provide this- but admittedly she does not feel they are skilled at it. She would like someone to come and train their staff to provide more of this in a more effective way. At one point she leaned over and whispered to Bekah and I "I think some of these girls may have HIV but their moms are refusing to get them tested- is there any way we can test them without them knowing?" Of course coming from an HIV clinic in the US my initial reaction was "Are you (swear word) kidding me?" But instead I explained how that would not work on a variety of levels. The very first one is "What if you did that and found someone to be positive? how do you tell them that they are HIV positive and you test them without their consent?" So we discussed how she could go about providing education to the families as to what kind of help the girls can get who may test positive for HIV. I thought of the World Wide Orphans Clinic. That might be a perfect match because of their experience in pediatrics and with families. I will make the connection as soon as I can. As Hanna said, "We need someone who is skilled at talking about HIV testing and treatment to come and provide the education so the families change their minds."

So what does Children's Heaven need aside from families to sponsor the girls? a landlord who wont raise the rent in 9 months? They need a counselor to provide therapy for the girls ad the staff - who as Hanna says- are exposed to the tragedies every day of helping kids who lead difficult lives and that tragedy builds inside and takes enormous tolls on health and emotional well being. And they need someone to come and do some teaching around safer sex and HIV testing and treatment. These are not pie in the sky goals. These are achievable. Doable and necessary.

The girls sang and dances for us and Michael had a great time- eating the popcorn and enjoying the smells of the coffee ceremony. Hanna has always loved Michael and he has such an affinity to her. (He cuddled with her shortly after they met- at a time when I was lucky to steal a smooch from him) and she gave him an awesome Ethiopian shirt the girls made which I will have to post pictures of- he LOVEd it. I am bringing back some of the crafts the girls and their moms have made for the Lights of Hope event in Portland in May!

Also the DSA Theatre Students will be coming to Children's Heaven in May to meet the girls- I am hoping the girls will teach the DSA kids some of their songs and vice versa. If you want to support the DSA Theatre students travelling to Ethiopia in May- I would encourage you to do so. They are working hard to make a meaningful trip and to really give back. Maybe they can help provide some education on the form of theatre when they come. If you want to help the get here email Shawn Hann at Shawn_Hann@dpsk12.org

Finally- and then its my bed time - If I was able I would post the cutest picture of Michael with two giggling little girls from Children's Heaven- your heart will melt.

World Wide Orphans Clinic

Today we started out visiting the World Wide Orphans Clinic. We got a little lost getting there as Bekah had never been to that part of the city before. I found it funny that we stopped and asked a couple of police men and they couldn't give us any directions. Bekah explained they really only know the small neighborhood they are assigned to and they are all on foot. We arrived and we met by Dr. Sophie Mengistu. We had a wonderful time talking to her about the care her clinic provides families with HIV. They started with just caring for a group of kids with HIV and their program has grown by leaps and bounds. They care for kids at most of the major orphanages which are home to HIV + orphans. They have a care center attached to their program with about 40 kids with HIV which is not associated with the other orphanages. They have patients from the community and have started providing care to the adults in those children's lives. They have an outreach program with a few locations because as she said "Most people will not come to this clinic for testing due to the stigma so we bring the testing to them." They provided 16,000 HIV tests last year alone. She showed me the VCT (Voluntary Counseling and Testing) logs and every page has about 50 names and on EVERY page in the column where you indicate the HIV test was positive there were at least 3-4 + tests. It made me think of our own CHIP clinic in Denver and how much our outreach program has grown and how many tests we provide each year- and how few we actually get as positive. They have a soccer team for the children, a summer camp program (where they work with the

Hole in the Wall Gang Camps- just like we partner with in Colorado for our New Round Up River Camp near Vail Colorado!) they also have drinkable water from a spigot outside their clinic which anyone can access. That was really cool. I also saw boxes of plumpynut and other nutritious lentil based food for families and the orphanages. (I took a photo of the plumpynut and might make a tee-shirt for Jennifer Dunn!)

The highlights of the day spent with her were reviewing case studies of HIV+ kids who have come home and what type of care and testing we provide them in the US and how what happens to them here in ET before arriving has an effect on their long term care. She was very interested in seing genotypes and looking at viral loads on medication and what changes we made to medication after kids come home. We talked about PK (medication level testing) and how the HIV medication levels can really cary by child and also when used in combination of other medications. We talked about how they make decisions based on symptoms and CD4 count. They actually do have the ability to get HIV RNA PCR testing (viral load testing which measures the amount of HIV virus in the blood- this is a test we use liberally here in the US which is not available in many parts of the world- particularly those countries where HIV is very much an epidemic) but because it is so expensive - it is not used often. I would love to see this test become more widely available because they would know much sooner if a child is failing a treatment regimen and that would help a child long term.

I was able to look at their new electronic database and even offer some suggestions based on the database we have at CHIP. I met the Phil Ferrero of WWO. She is a nice and as smart as our Phil. I was able to look at a few charts and found

the record keeping to be meticulous and very very comprehensive. I wished I had brought with me a copy of the medical records we receive on ours kids- because I got the impression she thinks we may have more information than we are actually getting. I have to say- these records would hold up to any site monitor visit- including one from Patrick Tshumper! We talked about TB treatment and the standard protocols as well as immunizations. She was curious how many kids come home showing that they had Hep A in the past (I think its almost all of them.) (She figured). It was a lot of medical stuff which is probably pretty dull for many of you reading this- but some of what I was impressed with was the connections they have made in the community and the other support programs they have in place. I met with the pharmacist who not only dispenses the HIV meds but provides adherence counseling..on average this can take about 45 minutes. (I asked if they are having issues with their teens not taking meds- the answer- no- kids in Ethiopia have to listen to their parents until they are 18). (It made me wonder how many kids from like 15-18 they had in their program still living with a parent because I think not wanting to listen to your parent when you are that age is pretty universal...it was implied that is not the case and may not be...I am a little cynical...certain developmental stages can't just be skipped!) :)

We Made It!

We made it- its a beautiful day in Addis. We are with our friend
Bekah and recovering from the lengthy but enjoyable flight. Aside
from losing a crown on the first of three legs, everything you can
imagine went so smoothly. We were on a brand new and very nice
Ethiopian Air plane which Michael loved (lots of gadgets) and we had
the whole row to ourselves which I loved. The visa and customs went
so smoothly. We didn't have to pay for any of our luggage and after
my trip to Romania several years ago when I lost all my luggage for
the entire two weeks, I always consider it a minor miracle when all my
bags arrive on the other side. So all 4 50 pounds bags with mostly
donations and items people requested made it...including a tube of

brewers yeast for someone who is making his own beer. I will be

requesting a sample in exchange for being his mule.

Michael was so curious about everything... how many seats

were on the plane, how big was first class, why did he feel like his own cool seat was first class, will he see animals, what is the fastest plane, how many engines, how do planes work, what if we crash, and many many many time change questions. He is now playing with our friends son in the country where he was born. He asked what the burning smell was. I would imagine that has some memory for him. Admittedly I was a bit teary eyed when we were in line for our Visa... remembering the last time we stood in that line and how much our lives have changed in 5 years. I was waiting for everyone to ask questions about what we were doing- Michael is still an Ethiopian citizen and so I wondered how people would react. No one asked a thing. I have never gone through customs where I am not even asked a single question. Nothing. She stamped everything and just said "Bye." I was fine with that.

I look forward to seeing the folks at Addis Kiddan later today- they
were the midwives in our adoption and it will be fun to see them.
Tomorrow the work, which is also fun, begins.

Kidane Mehret and Sisters of Charity

On my agenda is to spend some time at two other orphanages which care for kids with HIV. I chose these two because we have kids who have come home to Colorado from these care centers. I am excited to learn more of what life was like for the kids who came home before they got here. I will be meeting with the nurses and directors and providing some teaching based on case studies of children who have come to live in Colorado.

I am hoping that we will learn from each other as much as we can to make the transition better and maybe just maybe by providing a medical snapshot of the kids after they come home they can see how what happens in Ethiopia has a great affect on how they fare medically long term. I know that they probably know that is the case- but when you can see it on paper- I think it helps. I am bringing Bandaids, many many pill boxes, vitamins and some other medications.

You can check out the website for Kidane Mehret here. The other one, Sisters of Charity, doesn't seem to have a website but from what I have heard they care for 300 HIV + children and have just started allowing families to adopt these children. I have a new patient who lived there and I am really curious to see what its like.

Big thank you to Westerly Creek 2nd graders and Kindergarteners!

They did an amazing job collecting bandaids, vitamins, medication, and crocs. Here are some pictures of the kids!

Here are all the donations we got! You will also see many hair ties from three wonderful women!

Our newborn baby pictures of Michael

Obviously he is not a newborn here- we have to imagine what he would have looked like. Sometimes I hold him and describe how he must have looked to his Ethiopian mama. How sweet his little face was. How beautiful his long eyelashes are..how tiny he was...as she counted his toes and kissed his cheeks.


Michael was wearing size 18 month clothes but was really 4-5 years old. He was so tiny- but grew and grew that 1st year he was home.
Michael loved being on his new daddy's shoulders. This made him feel comfortable. Whenever he felt sad this was helpful in cheeering him up. They spent hours walking around like this in Ethiopia.

Visiting AHOPE

AHOPE was the first orphanage I knew about which cared for children with HIV. This was back when they would not integrate kids with HIV and kids who do not have HIV. Many places still will not do this. But some have come around. I was able to visit AHOPE when I traveled to bring Michael and Yabsera home. You can read about that here. I was excited to meet the nurse and talk about adherence and the medications they use, We talked shop so to speak and it was really nice. AHOPE has gone through as many changes as many of the other orphan related and adoption related program in the last 5 years but the biggest change is that families can adopt kids with HIV now with much greater ease and so there are actually families on wait lists for young children with HIV. Anyone who knows me well knows I don't like to sugar coat things and AHOPE has also has many struggles and challenges over the last 5 years. I hope though, like with any challenges we face, that we can learn and grow from them to create a better home for the children with HIV while waiting for families to adopt them. AHOPE has a supply list which I will post. We are doing our Band Aid Drive to bring band aids to AHOPE! I love this photo of the cook making piles and piles of Injera- the round spongy flat bread eaten in Ethiopia.

AHOPE Ethiopia
Supplies Update
For the month of February and March 2011

Medical Supplies
Gloves (Surgical and Disposable)
Hand sanitizer
Liquid Hand Soap
Multivitamins (gummy type)
Tablet cutter
Alcohol swab
Adhesive plaster
Hydrocortisone 1% cream
Antibiotic cream
Antifungal cream
Augumentin Syrups (156mg/5ml and 312mg/5ml)
Augumentin tablets (375mg)
Griseofluvin tablets (125 &250mg)
Stool Specimen Collector
Complete nurses gown

Nutritious and Sweets
Milks (infant formulas)
Candies, chocolates, lollipops
Cookies

Hygiene and skin care Supplies
Tooth past
Baby body wash
Diaper (Large Size)
Wipes
Diaper underwear
Aveno lotion
Shampoo & Conditioner
Liquid Soap
Hair bands
Towel (medium size)

Educational Supplies
Drawing/writing board, drawing pad
Stickers
Paint
Markers (permanent and removable)
Story books
Hard construction Paper
Pen (Blue & Red)
Puzzle
Dot pencil
Scissors
School glue

Clothes and Shoes
Trousers, pants, skirts, Dresses for older children (7-15 girls and boys)
Jackets, Sweaters, T-shirt, tops, blouses for older children (5-15 girls and boys)
Shoes for children size 6 above (10 years and above)
Slippers (crocks)
Shoes (7-15 girls and boys)
Shorts (7-15 girls and boys)
Pajamas for children (5-15)
Socks 7-15 (girls and boys)
Underwear 3-5 (girls and boys)
Swimming wears 4-15 (girls and boys)

Recreational and Psychosocial Supplies
Toys, Puppets
Cars big and small (with remote controls)
Video games
Toddlers/kids, Tins, Children movies, National geographies (VCD/DVD/VHS)
Diaries
Bubbles
Balloons
Puzzles
Scotch tape (transparent)
Paper Masking tapes (Big)

Sports
Basket ball
Foot ball
Magnetic darts for older children /teens

Others
Watch for children 7-15 (girls and boys)
Flash disks
Empty CD-R and DVD-R
Re writable CD

We brought them a bunch of little cars when we went last time!

Children's Heaven

One of the people I look forward to seeing again is Hanna Fanta. Many of you know her. She is the amazing founder of Children's Heaven. An organization designed to help pre-teen and teenaged girls be successful in school, help them to stay off the street, teach them about disease prevention and good health care, and promote self- esteem. It is an amazing organization and Hanna is wonderful.

Hanna has been to Denver where we have raised money through Ethiopian Orphan Relief to help her with funds to build a new home. Here is a photo of when she came.

The best blog posts about Children's Heaven are on my good friend Heidi's blog. I encourage you to read about Hanna and Children's Heaven here - especially the post about the Dumpster Girls. When we visit we look forward to meeting all the girls and finding out from Hanna how everything has been going with the new building space. I hope to have wonderful photos and stories of this when we return. These girls always need money for school uniforms. You can sponsor a girl through the website. She will send you letters and you are able to stay in touch with the child you are sponsoring. It is a wonderful organization.

BandAid Drive

We are doing a BandAid Drive in Yabsera and Michael's class. We thought it would be a fun way to teach the kids about Ethiopia, adoption, and health care issues in Africa. Many years ago, when I first went to South Africa in 2003 for the roll-out of Antiretrovirals in the pediatric population, it was hard for Phoebe to see me go. She was little - only about 4 and was really sad. So she made a "Phlat Phoebe" which I brought with me. Who knew how famous that flat girl would become. We made her into a story about going to Africa to work with some of the nurses and doctors to help the sick kids...when a few years later we brought home Michael and Yabsera the story grew with a new "chapter" talking about their adoption.

I have read this story to my kids classes every single year since 2003. There is usually something embarrassing- like when Phoebe was in 5th grade and I was reading it to her ENTIRE school and she did not want anyone to know that SHE had made Phlat Phoebe. We had to call her Phlat Maddie. Now she is famous among the children in Westerly Creek.

The most current point of embarrassment is the photograph showing Michael eating his 1st Dorito. He emphatically did NOT want this shown to his class. Of course I obliged. But will post it here since no one in his class is reading my blog. (She whispers)

I love reading the story because the kids get to see all the similarities and all of the differences and we get to talk about clean water and healthcare. We talked yesterday about why kids like bandaids and why they are good for us. The Kindergarten teacher said, "Remember class just the other day when we all went into crisis mode here in class because WE ran out of bandaids?" The looks on their faces of very grave concern were enough to prove that they did in fact, understand.

Another funny moment was when I was showing the class a photo of Michael's village in Ethiopia one of the children raised his hand and said, "I didn't know there were such things as 'villages' anymore." His eyes widened as I told him there are way more villages out there than there are big cities.

In the end all the classes were mostly interested in the fact that Michael can carry things on his head. He was forced to demonstrate this amazing skill to the collective oohs and ahhs of his classmates (and very real admiration from his teachers.)

I Was Not Their First HIV Health Care Provider

Whenever one of the kids with HIV come home to the Colorado who have been adopted by a family, we are able to review some medical records ahead of time. It is kind of a crap shoot how much we know about the child before we meet him or her. Many factors come into play, like the orphanage they come from, the access to medical care as well as the agency who is managing the adoption. Most of the kids see Dr. Sophie in the World Wide Orphans Clinic.

I have wanted to meet and talk with this doctor for years. I hope to learn more about the care the kids are getting while they are still in Ethiopia and share with her how they look when they come home. I want to talk to her about what we do here to help the children with some of their medical needs while they try and adapt to new families, new cultures, new foods, new rules, new routines. This is all happening while these kids are missing their best friends, their caregivers, and their Ethiopian families. They have suffered inexplicable loss, trauma, and fear like we can't imagine. The kind of stuff that just a lot of hugs and kisses alone won't heal.



I hope to share with Dr. Sophie the wonderful stories of families who persevere, who handle audiology, cardiology, radiology, and endocrinology visits with grace. How they navigate TB clinics, mental health visits, developmental screenings and mail order pharmacies (which if you know me well you know that those are the true bain of my existence), massive co-pays, and endless trips to the lab with stool samples and small frightened kids who have to stick their arm out once again for yet-another-poke.

If you would like to donate to help us bring some much needed medical supplies please click on the HIV to Home link to your left. Today they emailed and requested some pediatric sized IV bags so they can better serve the children in Soddo. We are leaving in about a week and are very excited.

Medical Supplies Needed

We will be visiting a hospital in southwestern Ethiopia. They are truly providing health care to some of the most needy folks on this planet. You can read more about the Soddo Christian Hospital in this well written blog post. You can either click here to read about a recent story when they had to care for multiple high risk cases all at once under difficult conditions or you can read about it below:

Life and Death in Soddo
This is Mark Karnes MD’s newsletter that went out on January 23, 2010. We have had so much interest in this letter that we wanted to also post it on our blog. At this writing, the mother that we gave blood to is doing quite well.
January 23, 2011
15/5/2003
I wish I were writing you a witty, cheerful newsletter this week, but the fact is my heart is breaking. Let me tell you about the events of yesterday. It was not all a disaster and there were many high points during the day. It began by Dr. Stephanie Hail asking to take first call and wanting me to “have a day off.” But that is a tad optimistic; because Stephanie, at this point, does not have her Ethiopian medical license so cannot take care of patients without my supervision. Also we had been inducing our doctor from the Netherlands, Dr. Ruth for three days and I fully intended on monitoring and delivering her baby. Because of significant chronic high blood pressure issues and thanks to our ultrasound we could tell that it was very necessary for her baby to be born, even though it was three weeks early. Alice had prepared supper for her the night before and breakfast yesterday morning. I took breakfast to her at the hospital and Alice came to meet me for a walk in the town. The morning was crisp and we had a lovely walk near the orphanage doing a circle at the edge of town looking down at the Great Rift Valley spread out below us. As we walked along the dirt road we chatted with many children and stopped to play table tennis with a few of them. Just as we were nearing the hospital my cell phone rang. It was Stephanie. She told me a patient had been referred from the government hospital, a woman with twins…the first one breech. Upon arrival I saw that Dr. Ruth’s blood pressure was getting higher and necessitated other medications. We took the patient to the operating room and while Stephanie stayed with Dr. Ruth, Dr. Teddy (the PAACS surgical resident) and I did the C-section. The mother was HIV positive. I wondered as I looked at her thin, emaciated body waiting for her spinal anesthetic on the operating table just how long she would live. Would her small breasts supply the needed nourishment for her two sons? She had two other children and this would be number 3 and 4. We have excellent antiretroviral medications now, but they have to be taken. Also, would she be able to give her two sons the ARV medications every 6 hours and give them a chance to grow up and experience life?
Her surgery went well but in the meantime I was informed of another patient who can just come in whose water had broken the day before. She had a high temperature and was dilated to 5 cms., but her baby was alive. We placed her on IV antibiotics and watched to see if she would make cervical changes but thinking that most likely she would need a C-section. As we were planning her care, we received word that a woman with a ruptured uterus had just been admitted to our “ICU,” which in reality is our recovery room. This was her fifth pregnancy. She had one 7 year old girl and the rest had died. She was acutely ill having travelled over 150 kilometers to get to Soddo. Her dead baby was coming “face first,” and she could not deliver it. Her abdomen was rock hard, filled with blood and her breathing was shallow and rapid. She asked me, “Can you save my life?” I told her there is only one Savior, Jesus Christ. After praying for her we got her ready to go to the OR. As she lay on the operating table, I held her hand and our eyes locked upon each other. As the nurse anesthetist was putting her to sleep, she started vomiting and I could see bile in the endotracheal tube. I yelled, “Suction her!” The anesthetist could not ventilate her lungs and she died right before our eyes; just a few short minutes before we had been looking at each other. Now she was gone. She had told me earlier, “I came here for you to save me.”
There was no time to grieve, however, because I had to get back to Dr. Ruth and check on the other patient. Stephanie had to stay at Ruth’s bedside because of the medications she was receiving and the fact that our OB nurses were not familiar with them and did not know how to take care of an acutely ill patient. Also, we have no IV pumps by which to monitor the rate of flow of medications. I was grateful that we had Magnesium Sulfate (brought into the country by Dr. Paul Gray) to help prevent seizures.
The patient with the high fever was now dilated to 8 but the baby’s heart rate had starting decelerating. It was time to get her to surgery. We delivered a live, big baby girl. But while still in the OR we received news that another patient that had arrived with a ruptured uterus! I quickly went to the “ICU” and this patient also had traveled over 150 km. to our hospital. This was her fourth pregnancy and she had delivered one baby the day before. She could not deliver its twin and in the process had ruptured her uterus. Her bare feet were caked in mud from squatting on her dirt floor trying to deliver her baby who refused to be born. Her respirations were shallow and rapid. Her abdomen was exquisitely tender. Her blood count was dangerously low. Her mother asked me, “Please save her.” I told her husband and relatives she needed blood and called Alice to come down that her O+ blood was also needed. All gave. This time, I had a different nurse anesthetist and she put down an NG tube into her stomach before putting her to sleep, draining a tremendous amount of bile. She was successfully intubated and upon opening her abdomen I discovered a 15 cm rent in her uterus. Her abdomen was filled with blood. I grabbed a foot and delivered her stillborn baby boy. Upon closing her uterus the electricity went out and I held my hand firmly on a bleeder while waiting in the dark for our hospital generator to kick in. Ninety seconds later it did and we were able to finish the operation. The mother is still alive this morning and has one unit of my wife’s blood in her.
The highlight of last night was the delivery of Dr. Ruth’s tiny baby boy, Ephraim, all 4 ½ lbs. of him! I was so grateful we had induced her labor because upon examining the placenta afterwards a portion of it had infarcted. It was a blessing that we had a live healthy baby boy and mother.
I’m sorry this is long but wanted to share some of the events of yesterday with you. We have so many pressing needs here…good blood pressure cuffs, good light sources (I used a head light flashlight for the delivery of Dr. Ruth), decent surgical instruments that work, and an IV pump. We are desperately low in suture. These are the realities of practicing obstetrics and gynecology in Ethiopia. Thank you for your prayers and continued financial support. We cannot do this without you.
Mark and Alice