Bangkok Beauties

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I am behind in posting and on my way to yet another country, but I have to share some of my favorite shots from glittering, colorful, crowded Bangkok. The city was dense with people, smog, heat, and humidity, but around each corner emerged a bright temple or wat or shrine, with red tiled roofing and glittering gold statues, the smell of incense offerings and bright flower wreathes piled at the feet of Buddhas. It was a fascinating place. What my camera saw…

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Bangkok: Launching our project with the Thai Red Cross HIV Center

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My latest research adventures brought me to Bangkok, where we launched and trained another site for our project to figure out the best way to monitor children’s adherence to HIV therapy across sites around the world. I really love seeing this work expand across the global sites providing HIV care.

The Thai Red Cross has been caring for patients with HIV in Bangkok since 1985. They are true pioneers in what it means to provide HIV care for patients in poor places. In the Thai Red Cross HIV Research Center, they provide care for a large number of children, adolescents and adults who are also enrolled in key AIDS research studies. Most of their children are on the older end because they have been providing HIV care for so many more years. This makes them a great site with which to work to figure out the challenges of transitioning children with HIV into adolescence and adulthood.

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Not only was this site well-equipped to launch our new research project, but they enthusiastically welcomed me to do teaching for two of the medical schools in Bangkok about pediatric adherence to HIV therapy. Moreover, the Thai Red Cross team hosted us with great enthusiasm, making sure my program manager and I saw the highlights of the city and ate, ate, ate our way across Bangkok. Such fun.

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Cape Town

I am a bit behind in my travel documentations, but I cannot neglect the beauty of Cape Town. I had always heard the Cape was beautiful. In the midst of busy weeks of setting up projects to follow children’s adherence to HIV medicines, escaping for a weekend in this glory of the water and mountains and sky and sunshine was pure delight.

I felt like Cape Town was constantly showing off — just one ridiculous scene after another, each sunset and sunrise and beach more spectacular than the next.

My camera and I loved this glory.

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Research Fun in Johannesburg

For me, the whole reason to do health research is to figure out how to make healthcare work better. I wanted to know what would work. I ended up in global health research (As an English major! Who hates statistics and math!) because the issue of how to save the lives of children in the poorest parts of the world was critically important to me. I wanted to tackle big, giant problems killing children and I wanted to know what solutions would really make a difference.

I wanted to figure out how to best care for children with a really complicated disease who are growing up the poorest parts of the world. If you can create a healthcare system that can do that, you can do anything. That’s why I do research.

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This week has been a really exciting step in seeing those dreams come into fruition. For years, I have been struggling with the challenge of how to know which families in Kenya are having the most problems with maintaining HIV therapy for their children. We know it’s a major challenge to have a child taking 3-4 different medicines two days a week for the rest of their life, and we need to know how we can help families with that challenge. We have studied this like crazy in Kenya. Now, we are starting to look at the rest of the world’s HIV programs.

I chair the global consortium of programs providing HIV care for children (called IeDEA), and we want to figure out a consistent way to measure children’s adherence to HIV medicines for HIV care programs around the world. This week’s exciting step for that has been to test out the procedures we have been developing in Kenya, and to see how they do when you use them at other sites in East Africa, South Africa, and Asia.

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Launching this new project at the Rahima Moosa Children’s Hospital in Johannesburg, South Africa has been ridiculously fun. All week, my program manager and I have been doing training sessions here in Johannesburg and learning about this clinical system — all to get ready to launch an HIV medication monitoring project here.

They have a lot more resources than our clinics in Kenya, but they also serve a very poor population of children and their caregivers. Spending time in the largest child HIV clinic here in Johannesburg feels like home; bring me to the children and families struggling with HIV in the poorest parts of the world, and I am among my people. (And I can speak to these families in English! Such a delight for explaining things!) The South African clinicians and I have bonded over our shared challenges.

Johannesburg has more resources than Kenya (And roads! And wine! And shopping!), but they also still have a major HIV problem here. Among the pregnant women coming to the largest mother-baby hospital to have their babies, 1 in 3 has HIV. ONE in THREE pregnant mothers. HIV is still everywhere. Passing this terrible virus into the bodies of beautiful babies and children.

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I love new ideas, and of course, new ideas are born daily when I am among my kindred hearts. We keep dreaming up more and more ways to collaborate across Eastern and Southern Africa to help our families. We struggle with so many of the same challenges. And we want to answer questions about what will work and about how to provide better care for families with children with HIV.

Long days, but fun, fun, fun.

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I want a magic wand.

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If I had a magic wand, I would give Wangari parents.

Wangari is small for her 8 years and getting smaller. She is a frail, meek girl who sits quietly on the chair in front of me in this distant, rural HIV clinic close to the border of Kenya and Uganda. She is wearing filthy, tattered clothes and smells of the kind of deep poverty that makes one pay attention in even a very poor place.

Wangari lives with her grandmother, a woman too old and weak to make the journey to HIV clinic, and so she was brought in for this appointment to see the visiting pediatrician by a neighbor.

She really should have been started on the medicines to fight the HIV virus quite a few months ago, but without a mother or a father to take responsibility for giving her medicines — with only this ancient grandmother — no one was sure that she should be started on HIV medicines at all.

On this day, lacking my magic wand, but having a fairly magic prescription pad, I decided we didn’t have any other choice. Wangari is losing weight, and her body is being taken over by the diseases of the skin and mouth and lungs that sneak in when your immune system is non-existent.

I talked to the neighbor for a long, long time, drawing pictures and asking questions, trying to determine if she was really serious about helping this little girl take these 4 medicines twice a day and if she understood the weight of this treatment. She needs these medicines every single day. Let’s see if there is any possible way to make this happen.

With these medicines, Wangari will grow again. She will be able to laugh and play and go to school. These medicines mean a future for this little girl. But who will give them?

I tried to involve the social workers to follow up with a visit to Wangari and her grandmother. I tried to convince our nutrition support team to make sure there is enough food, but I just don’t know if this will be enough.

Wangari’s little body was covered with scars collected over a childhood of no one caring too much what happens to you. I wished I could erase her scars. I wished for a magic wand.

But if I REALLY had a magic wand, I would use it for the emergency…

From my imaginary valentine, Bono, a few years ago:

I became the worst scourge on God’s green earth, a rock star with a cause. Christ! Except it isn’t a cause. Seven thousand Africans dying every day of a preventable, treatable disease like AIDS? That’s not a cause, that’s an emergency. And when the disease gets out of control because most of the population lives on less than one dollar a day? That’s not a cause, that’s an emergency.

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