Into Africa: An Ottawa doc­tor’s quest to help

Five years ago, a lo­cal doc­tor with no ex­pe­ri­ence in for­eign aid hopped on a plane to Gabon with some vol­un­teers and a lot of good will. Since then, Don Kilby’s group has treated thou­sands of pa­tients in Africa and sent mil­lions of dol­lars worth of med­ica

Ottawa Citizen - - News - BY DAVID SACHS

TKILEMA, Tan­za­nia he Tan­za­nian foothills be­low Mount Kil­i­man­jaro are alive, green with ba­nana and avo­cado trees, flow­ing with streams and wa­ter­falls. Even the wet red clay seems as flesh. It’s a vi­sion of life jux­ta­posed with the stench of death, the sickly sweet trop­i­cal smell of rot­ting leaves and fruit. Hid­den in this jun­gle Eden is a dense maze of shacks con­nected by foot­paths and a pop­u­la­tion plagued with a 20-per-cent HIV in­fec­tion rate — on top of malaria, mal­nu­tri­tion, tu­ber­cu­lo­sis and dysen­tery.

Th­ese hills are a front line in the bat­tle against AIDS in Africa, and an Ottawa group is an ac­tive com­bat­ant, pro­vid­ing funds, equip­ment, vol­un­teers and a life­line to the out­side world.

CACHA, the Canada Africa Com­mu­nity Health Al­liance, has been sup­port­ing this com­mu­nity through Kilema Hospi­tal, the health cen­tre for this rural dis­trict. With CACHA’s help, food and cloth­ing are reach­ing or­phans in the sur­round­ing vil­lages and an In­ter­net con­nec­tion pro­vides hospi­tal staff, many of whom have never used a com­puter be­fore, with a link to the West.

This sum­mer, a Cana­dian ship­ping con­tainer ar­rived with used hospi­tal beds, op­er­at­ing ta­bles, an ul­tra­sound, a por­ta­ble X-ray, anes­the­sia ma­chines, books, cloth­ing — vil­lage chil­dren can be seen in NHL jer­seys — and much more. A mod­ern HIV cen­tre is be­ing built at the hospi­tal, just be­low the live­stock pens and the nun’s res­i­dence with the satel­lite dish on the roof.

In its five years of ex­is­tence, CACHA has sent well over $2 mil­lion in med­i­cal equip­ment to African hos­pi­tals and or­ga­ni­za­tions. Their med­i­cal car­a­vans, which part­ner Cana­dian vol­un­teers with doc­tors in Gabon, Benin, and Tan­za­nia, have seen tens of thou­sands of pa­tients.

CACHA was the brain­child of Ottawa doc­tor Don Kilby, a gen­eral prac­ti­tioner, HIV spe­cial­ist, and the di­rec­tor of Ottawa Univer­sity Health Ser­vices. When Ot­tawaHull hosted the Jeux de la Fran­co­phonie in 2001, Dr. Kilby’s unit hosted the in­ter­na­tional med­i­cal staffs. Al­though he had no ex­pe­ri­ence in in­ter­na­tional health and de­vel­op­ment, Dr. Kilby ap­proached West African physi­cians look­ing for part­ners to bring med­i­cal care to iso­lated rural com­mu­ni­ties. Less than seven months later, on St. Valen­tine’s Day, 2002, Dr. Kilby and his team of vol­un­teer med­i­cal stu­dents, nurses and doc­tors were off for Gabon, helped by a $75,000 grant from the Cana­dian In­ter­na­tional De­vel­op­ment Agency (CIDA).

“We went as green as can be,” Dr. Kilby says. “I had an idea what we wanted to do, and com­mu­ni­cated with our part­ners over there, and we just got on a plane and went.”

While the team was pre­pared for the work and health is­sues they faced, the cul­ture and en­vi­ron­ment stumped them at first.

“I didn’t ap­pre­ci­ate how slow things can be, how dis­or­ga­nized things seem to be and how un­af­fected by all that our part­ners seem to be,” Dr. Kilby re­calls. “Lit­er­ally, to be left on the side of the road wait­ing for your trans­porta­tion and it doesn’t show up, and it’s get­ting dark, and you’re stick­ing your thumb out in the mid­dle of the jun­gle try­ing to get a ride back to the city.”

Here at Kilema, the hospi­tal faces con­di­tions like an African M*A*S*H unit. A nun/sur­geon/sol­dier named Dr. Sis­ter Clarissa guides her staff through power out­ages, poor hy­giene, an­ti­quated equip­ment, over­crowded wards, and crow­ing roost­ers.

The doc­tors work un­der th­ese con­di­tions for lit­tle pay (around $2,500/year). To imag­ine the se­nior staff, think of the Bea­tles. Dr. Mbando is Ringo, the charis­matic clown. Dr. Mas­sawe is Ge­orge, play­fully se­ri­ous. Dr. Mgase is Paul, the baby-faced shy one. and Dr. Mushi is John, the philoso­pher: “When we make de­ci­sions, then we be­come masters of our own des­tiny. And it is good.”

Sis­ter Clarissa is the kind of leader Sub­Sa­ha­ran Africa needs more of — an in­ter­na­tion­ally trained pro­fes­sional who has re­turned home. Soft-spo­ken yet force­ful, Kilema’s doc­tor-in-charge was born and raised in the re­gion. She joined the sis­ter­hood as a teenager and en­rolled in med­i­cal school along with three other sis­ters. Af­ter school came a year of na­tional ser­vice in the army: “We got to play with guns and have fun,” she says.

On sev­eral oc­ca­sions, west­ern col­leagues have helped Sis­ter Clarissa fur­ther her skills abroad, do­ing surgery train­ing in Ger­many and fur­ther spe­cial­iza­tion in re­pro­duc­tive health in Bri­tain.

Poverty is the over­whelm­ing fact of life in this home­land for the Chagga tribe. Ac­cord­ing to vil­lage lead­ers, the av­er­age fam­ily in­come here is be­tween $50 to $100 per year, mainly from grow­ing cof­fee. Diet is very ba­sic — ba­nana, maize, beans and yams. Fam­i­lies may have a goat or a few chick­ens, but meat is re­served for spe­cial oc­ca­sions. Per­haps a third of the homes have elec­tric­ity and few have clean wa­ter.

Poverty walks hand-in-hand with dis­ease, and it has been CACHA’s guid­ing phi­los­o­phy to im­prove, as Dr. Kilby says, the “de­ter­mi­nants of health,” rang­ing from hy­giene to ed­u­ca­tion to em­ploy­ment.

The way CACHA helps Joseph — a young boy ad­mit­ted to Kilema Hospi­tal with se­vere burns to the face and hands — demon­strates the group’s approach. Joseph’s fa­ther died of AIDS, his mother and two sib­lings are HIV-pos­i­tive, but Joseph has so far been neg­a­tive. While he was in the hospi­tal, his fam­ily’s mud and wood hut col­lapsed. Joseph is part of a CACHA pro­gram to care for the com­mu­nity’s hun­dreds of AIDS or­phans and vul­ner­a­ble chil­dren, which en­sures the most needy get school fees and med­i­cal ex­penses cov­ered while pro­vid­ing es­sen­tials like flour, rice, cook­ing oil, soap and cloth­ing. In Joseph’s case, CACHA funds are also be­ing used to re­build the fam­ily’s home.

The slow pace of progress in Africa can be a frus­tra­tion for western­ers, but things are get­ting bet­ter: AIDS pa­tients at Kilema are liv­ing longer and re­turn­ing to work and trans­mis­sion to ba­bies is down, thanks to crit­i­cal ARV (anti-retro­vi­ral) drugs the gov­ern­ment now sup­plies free. Ed­u­ca­tion in fight­ing malaria is bet­ter. But the HIV in­fec­tion rate is not go­ing down. For one thing, con­doms are too ex­pen­sive for any­one liv­ing off $50 a year. The hospi­tal it­self is run by the church, and doesn’t pro­mote con­dom use. This is one of the cul­tural ob­sta­cles CACHA must ac­cept.

“The con­doms are a chal­lenge,” Dr. Kilby ad­mits. “But in the scale of all the things you have to do to keep peo­ple healthy, con­doms are a very small piece. And now you’ve got a struc­ture there that’s or­ga­nized, well oiled, trust­ful, ac­count­able, that can give you good pre-na­tal care, good in­fant care, can give you ARV treat­ment, can hos­pi­tal­ize you and treat you for your op­por­tunis­tic in­fec­tion, give home based care, take care of the or­phans … We’ll find other ways to dis­trib­ute the con­doms.”

As Dr. Kilby ex­plains, many peo­ple don’t get in­volved in de­vel­op­ment work sim­ply be­cause the scope of the prob­lems of African health and poverty seem so im­pos­ing. To Dr. Kilby, this only means there are a mul­ti­tude of op­por­tu­ni­ties to do good.

In­deed, the suc­cesses are be­gin­ning to mul­ti­ply, Dr. Kilby says.

“Af­ter work­ing in Gabon five years now, word of mouth goes around: the Cana­di­ans are back again, they’re do­ing con­sul­ta­tions, they’re pulling teeth, they’re do­ing mi­nor sur­gi­cal pro­ce­dures, they’re giv­ing out med­i­ca­tion. We went into vil­lages where peo­ple had seen Al­bert Sch­weitzer in the ’60s and hadn’t seen a doc­tor since. ... Now we have in­flu­en­tial peo­ple in that coun­try found­ing their own foun­da­tion to do the same kind of work on an on­go­ing ba­sis.”

For Dr. Kilby and CACHA, there is a grow­ing sense of sat­is­fac­tion that they are mak­ing a dif­fer­ence. He re­calls that the pres­i­dent of Gabon sent a let­ter to Canada’s prime min­is­ter to say that “of all the in­ter­ven­tions that Canada has had in our coun­try, this one has been the most sig­nif­i­cant, it’s the one that has touched the hearts and minds of our peo­ple the most.” Free­lance jour­nal­ist David Sachs vol­un­teered with CACHA at Kilema Hospi­tal.

www.cacha.ca, 613-234-9992 Net of­fi­cial de­vel­op­ment as­sis­tance as a per­cent­age of Gross Na­tional In­come in 2005. The United Na­tions has set a goal of tar­get­ing 0.7 per cent of a coun­try’s GNI to­wards for­eign de­vel­op­ment aid: Swe­den 0.94 Nor­way 0.94 Nether­lands 0.82 Lux­em­bourg 0.82 Den­mark 0.81 Bel­gium 0.53 Aus­tria 0.52 France 0.47 United King­dom 0.47 Fin­land 0.46 Switzer­land 0.44 Ire­land 0.42

Ger­many Italy Ja­pan Spain New Zealand Aus­tralia U.S. Por­tu­gal Greece

0.36 0.29 0.28 0.27 0.27 0.25 0.22 0.21 0.17

DAVID SACHS FOR THE OTTAWA CIT­I­ZEN

Dr. Don Kilby is the founder of the Canada Africa Com­mu­nity Health Al­liance. Dur­ing the past five years, CACHA has sent more than $2 mil­lion in med­i­cal equip­ment to African hos­pi­tals and or­ga­ni­za­tions.

COUR­TESY OF CACHA

Dr. Sis­ter Clarissa runs the hospi­tal in Kilema like an African M*A*S*H unit. Raised in the re­gion, this nun/sur­geon/ sol­dier re­ceived in­ter­na­tional help to hone her med­i­cal skills in Europe.

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