What One Person Can Do: A Video from Maseno, Kenya -- by Dr. Christiana Russ

EGR blogger Christiana Russ -- a pediatrician who splits her time between Boston and Kenya -- offers this video her brother put together to describe the work of the Mother's Union of Maseno and the deworming program that they are doing there.

It's a great story of What One Person Can Do, and the key is that when Christiana showed up in Maseno, the first thing she did was ask questions and listen. Then she looked at how she offer her gifts in partnership with the gifts of the wonderfully gifted people (in this case, the Mother's Union) who were already there. What resulted was an incredibly low-cost solution to a debilitating problem.



Dr. Christiana Russ is a pediatrician doing her residency at Boston Children's Hospital, currently working at an Anglican mission hospital in Kenya through a joint arrangement with Children's and the Diocese of Massachusetts. She is also chair of the Executive Council Standing Commission on HIV/AIDS.

"Mothers Union Pharmacy Project" -- by Dr. Christiana Russ

I am just returning from 3 weeks in Kenya and a week in South Africa. In Kenya I was working with the diocese of Maseno North Mother’s Union on a de-worming project that we started just under a year ago. It was an extraordinary experience and we gave medicine to treat intestinal worm infections in approximately 2500 children at about 10 parishes while I was there. The women were planning to reach another 5 parishes after I left. Seeing so many children, most of whom are either orphaned by AIDS or otherwise vulnerable, is overwhelming. When they sing to you in welcome, it’s indescribable, particularly when you and they know that you came to give them 5 unfortunate tasting tablets to chew and swallow.

At several of the parishes there was a child brought forward with obvious longstanding illness. One boy had a bad infection in his lower leg, which upon taking him to the hospital was found to involve a fractured bone as well. Another girl had terrible looking eyes – bright red with ulcers visible on her cornea. Severe vitamin A deficiency can do that, but so can other things.

Neither of these situations is unusual. Visits to these rural parishes, especially the more remote ones, usually turns up one or two children who are in serious need of medical attention, and whose illnesses are so progressed that they’ve clearly been worsening over a period of weeks to months. The overall infant and child mortality is very high in this region of Kenya, an indication that a lot of children get quite ill and don’t receive medical care. It is common however for families to purchase over the counter medications to try to treat illnesses themselves. So I was especially interested when I heard about a new possible venture for the Mother’s Union to address this problem.

Several of the women have received some training as community health workers and others are interested in it. A public health professor visited Maseno recently and had the following idea: give a few women in each parish start-up money for a pharmacy which they can run in their rural area with medication obtained from the hospital. Medications such as Tylenol, ibuprofen, anti-malarials and basic antibiotics are available in pharmacies around Kenya, but studies have shown up to half of them or more don’t actually contain adequate active ingredient. Medications at Maseno hospital are purchased from a company that checks the meds, so they are known to be good. While selling medications to treat simple and common complaints, these women can also be trained to pick out danger signs or indicators that someone needs to be referred to hospital. They could screen for malnutrition and refer kids to the hospital if necessary or potentially to a feeding program. With some training they could function quite well as community health workers while simultaneously making a bit of money.

I was so excited about this idea that I am using money donated from St. Christopher’s Episcopal Church in Chatham, MA to start a pilot project in two of the parishes. If it goes well we can fund-raise to expand it. If we can find a way to pick out children (and adults) who need true medical attention earlier in their disease process, we will be able to alleviate a lot of suffering.

To find out how you and your church can support the Mothers Union Pharmacy Project, contact Christiana here.

Dr. Christiana Russ is a pediatrician doing her residency at Boston Children's Hospital, currently working at an Anglican mission hospital in Kenya through a joint arrangement with Children's and the Diocese of Massachusetts. She is also chair of the Executive Council Standing Commission on HIV/AIDS.

"A Prayer for Children" -- submitted by Dr. Christiana Russ

For her post this month, Dr. Christiana Russ offers this poem that was shared with her by her mentor at Children's Hospital in Boston. Christiana is a pediatrician who splits time between Children's and an Anglican hospital in Maseno, Kenya.

[from A Prayer for Children by Ina Hughs. Wm. Morrow and Company, NY., 1995. Pgs XIV-XV.]

We pray for children
who sneak popsicles before supper,
who erase holes in math workbooks,
who can never find their shoes.

And we pray for those
who stare at photographers from behind barbed wire,
who can't bound down the street in a new pair of sneakers,
who never "counted potatoes,"
who are born in places we wouldn't be caught dead,
who never go to the circus,
who live in an X-rated world.

We pray for children
who bring us sticky kisses and fistfuls of dandelions,
who hug us in a hurry and forget their lunch money.

And we pray for those
who never get dessert,
who have no safe blankets to drag behind them,
who watch their parents watch them die,
who can't find any bread to steal,
who don't have any rooms to clean up,
whose pictures aren't on anybody's dresser,
whose monsters are real.

We pray for children
who spend all their allowances before Tuesday,
who throw tantrums in the grocery store and pick at their food,
who like ghost stories,
who shove dirty clothes under the bed and never rinse out the tub,
who get visits from the tooth fairy,
who don't like to be kissed in front of the carpool,
who squirm in church or temple and scream in the phone,
whose tears we sometimes laugh at and whose smiles can make us cry.

And we pray for those
whose nightmares come in the daytime,
who will eat anything,
who have never seen a dentist,
who aren't spoiled by anybody,
who go to bed hungry and cry themselves to sleep,
who live and move, but have no being.

We pray for children who want to be carried
and for those who must,
for those we never give up on and for those
who don't get a second chance.
For those we smother…and for those who will grab the hand of anybody kind enough to offer it.

[The poem was written following the Oklahoma City bombing by Ina Hughes, columnist for the Knoxville News-Sentinel.]

Dr. Christiana Russ is a pediatrician doing her residency at Boston Children's Hospital. She also spends time at an Anglican mission hospital in Kenya through a joint arrangement with Children's and the Diocese of Massachusetts. Christiana is the chair of the Executive Council Standing Commission on HIV/AIDS.

"Opportunity" -- by Dr. Christiana Russ

We've just finished celebrating the Fourth of July – a day in which we celebrate our independence and our freedom here in the United States. Freedom is often painted in a military way – freedom of speech, freedom of religion. As I watch attempts to protest in other countries on TV, of peaceful gatherings that get violently broken up be it in Tibet or in Zimbabwe, I can remember and appreciate our freedom to speak out against what we view as wrong, even against our own government. Reading about women in some Muslim countries who are abused for inadequately covering their heads or faces again prompts me to thank God that as a woman living in the United States, I can go outside on a hot day in shorts and a t-shirt. Today is a day to relish and give thanks for our substantial freedoms.

Amartya Sen, a brilliant economist and winner of the Nobel prize, wrote a book called ‘Development as Freedom.’ He talks about development of individual freedom as a social commitment, and expansion of freedom as ‘the primary end and principle means of development.’ By freedom he not only refers to political freedoms and economic facilities, but also to social opportunities (health care, education), transparency and protective security. He argues that as these freedoms expand, people’s economic opportunities expand and communities develop further.

So when I think about freedom this time of year, the person I think of and pray for is a man named Silus. Silus lives in Maseno in western Kenya. If you’ve read my blogs before you will know that I worked at Maseno Hospital, an Anglican mission hospital, for several months last year as a pediatrician. Silus worked at Maseno Hospital as a clinical officer – having had a few years of medical training after high school. To say he was clinically good is an understatement. I have been in many African hospitals where despondency reigns, and in my experience Silus was a bright light against despondency at Maseno Hospital. He would go the extra mile for his patients, cared about not just their medical problems but social problems as well, and worked incredibly hard to provide them with the best medical care he could muster in a place with limited resources.

So I was absolutely delighted to find out several months ago that Silus was accepted to medical school in Kampala to start this fall. However Silus does not have the same economic freedom that I once had as an aspiring medical student. He doesn’t have parents who can help him financially. He doesn’t live in a country with low interest rate, easily obtained student loans (for good discussion on the ability to take out loans as a right and freedom read Muhammed Yunus’s book, Banker to the Poor).

Silus needs $2600 per year for tuition and hopes to raise an additional $1400 per year for living expenses for the next 5 ½ years of school. I have spoken with a few individuals and groups about raising this money and haven’t found it easy. There is no guarantee that Silus will return to help out in Maseno Hospital upon his graduation, and we have little infrastructure for such a long term investment. Thus people focusing on Maseno are understandably reluctant to divert money to an individual.

And yet incredibly good things can come of having one more well trained, clinically astute and socially responsive physician in Africa, which is in desperate need of more such people.

So today I pray for Silus, that through friends and organizations he will be able to raise the money to obtain the freedom of furthering his education as a doctor. I pray he will use that freedom well to improve the health care and opportunities of the patients he works with. I pray that those few drops of freedom expand opportunities and increase development as Amartya Sen describes, to touch more and more lives.

Dr. Christiana Russ is a pediatrician doing her residency at Boston Children's Hospital and splitting her time at an Anglican mission hospital in Kenya through a joint arrangement with Children's and the Diocese of Massachusetts. She is also chair of the Executive Council Standing Commission on HIV/AIDS.

If you want to learn more about how you can help Silus, you can contact Christiana at cmruss(at)gmail.com.

"Us vs. Them" -- by Dr. Christiana Russ

I recently went to the presiding bishop’s summit on domestic poverty in Arizona. It was a wonderful think-tank comprised of people who do all varieties of work combating poverty in the United States. At the start of the meeting the point was made that while the Millennium Development Goals are important there is a need to focus on the poverty and deprivation that continues to persist within our own borders, despite our substantial GDP. This is absolutely true. It also made me sit back and think hard about our very human experience with limited resources and time, and thus our need to carve up how we spend those resources and time.

I am the chair of the executive council committee on HIV/AIDS and in our committee we have this conversation quite often. How much effort should we continue to put into pointing to the ever present but changing face of the AIDS pandemic in the United States? Does focusing on the international pandemic pull attention from the domestic problem and allow people to rest in false comfort of AIDS being ‘over there’? Or is there a way to see the commonality of the problems facing people both infected and affected by HIV in Africa, Asia, South America, our very own Province IX and in the borders of the United States?

In all of these places people face stigma, people face their fears of illness and dying, people struggle for access to healthcare, and family members care for orphaned children and ill loved ones. The magnitude of those particular problems might vary among individuals especially depending on their economic resources, but they are still very present and I believe the church is called to respond to every one of them.

We encounter a similar dilemma with poverty. I have heard people who work on domestic poverty dismiss international aid work as ‘sexy’ and lament the lack of people rolling up sleeves and going into their own backyards. Those comments fail to recognize that many of the problems of poverty are pretty similar in the U.S. and in Africa. I have met some of the loneliest and most deprived people imaginable while working with the homeless on the streets of Boston. And I have seen children alone and starving in Africa. Authentic relationship with each of those people forces us to face their needs which are enormous both materially and spiritually.

Good thing our God is so big and that His economics are all about abundance and love.

We also talked at the summit about having enough faith to dream big and step forward to do the work we are called to do… each according to his or her own gifts. The need of the world can be entirely overwhelming and yet at the root, many of the sorrows that people share across the world are the same. When we find those areas of similarity and focus on the synergy that can come from solving the same problem in different settings – amazing things can happen. When we trust in a God of abundance instead of viewing ourselves as competing for scarce resources or attention, again amazing things can happen. I pray that our church will have a big enough heart to care for people over there and over here.

Dr. Christiana Russ is a pediatrician doing her residency at Boston Children's Hospital, currently working at an Anglican mission hospital in Kenya through a joint arrangement with Children's and the Diocese of Massachusetts. She is also chair of the Executive Council Standing Commission on HIV/AIDS.

"The Bishop Masereka Medical Centre -- best practices for medical care in Uganda" -- by Dr. Christiana Russ

I have spent the past three weeks in Kasese, a town in western Uganda. I was a guest of a retired Anglican bishop Zebedee Masereka and his wife Stella. They invited me to come do some pediatric work at their health clinic – the Bishop Masereka Medical Centre, which functions under the umbrella organization called Bishop Masereka Christian Foundation.

I have a tendency to rant about the quality of health care provided in places which display a cross and are purportedly Christian. In far too many of these clinics you find poor staffing with inadequate training, insufficient supplies, too much dirt, and a level of ‘care’ that would inspire anyone but the most desperate person to stay home until knocking on death’s door scares them into seeking help. They come too late, there is little that can be done and adequate interventions at that point are very expensive. When they succumb their family and friends remember only that medical care didn’t help and cost a lot, and thus the grisly cycle continues.

At the Bishop Masereka Medical Centre (BMMC) I have seen a model of how things can be done differently. First, and perhaps most importantly, the Bishop and Stella urge their staff to treat their patients lovingly. Isn’t that, after all, how we as Christians are to be known?

The BMMC also strives to provide excellent medical care. They have hired a physician, Dr. Daniel, who recently graduated from medical school in Uganda. He pushes the staff to make decisions based on evidence. He encourages people to think of other causes of fever besides malaria. He insists on treating each patient well – so much so that when a 13 year old girl was diagnosed with TB and lost to follow up, he went into the town to find her so she could begin her treatment. The staff counselor then met with the girl’s family and community to teach them about TB. A few days later a woman came in with a ruptured ectopic pregnancy which is a surgical emergency. Dr. Daniel not only ensured that she was referred to a hospital with an operating theatre, but he also went several hours later to make sure they had done the surgery quickly and that she had stabilized. This is evidence of medical care, true care, and this is also why the number of patients at the Bishop Masereka Medical Centre is increasing rapidly.

Dr. Daniel and the Bishop are working hard to raise funds for their clinic. They hope to move out of their cramped, rented rooms and build a small hospital replete with operating theatre, full lab and radiology facilities. They are chasing down local businesspeople seeking donations and are planning to take out loans as needed. The care they provide isn’t free, but it is quality care that is worth the cost, and they have some donor funds that assist in running the clinic (such as the physician’s salary).

It is my prayer for Africa that health facilities such as the BMMC will continue to spring up in small towns like Kasese, where they are most needed. I pray additional dedicated and smart doctors, nurses, counselors and other staff will be trained well and will invest in improving the health care in these communities. When the quality of health care that is offered improves, and when it is given with love, people do come. It is astonishing and miraculous to witness the dramatic healing that can sometimes happen then.

Dr. Christiana Russ is a pediatrician doing her residency at Boston Children's Hospital, currently working at an Anglican mission hospital in Kenya through a joint arrangement with Children's and the Diocese of Massachusetts. She is also chair of the Executive Council Standing Commission on HIV/AIDS.

"Abundance" - by Dr. Christiana Russ

These past few weeks I have been thinking a good deal about abundance. In my last blog I had written some about the culture shock of returning to the United States during the Christmas season, and the incredible and overwhelming abundance of material things that we are blessed with. Lately I have been thinking about God’s abundance instead.

We are used to working with models of scarcity. We talk a lot in development about ‘sustainability’. In the church the catch phrases such as ‘good stewardship’ might have us thinking along the same lines. I recently was talking with an HIV committee at a church group and heard the quote ‘Do what you can, with what you have, where you are.’ spoken by Theodore Roosevelt.

So that is a very good and reasonable way to approach economics – distributing scarce resources. I think the quandary faced by those of us who claim to believe in a God of abundance is that we sometimes get trapped into believing our resources are scarcer than they are.

Let me explain a bit further. I work part of each year as a pediatrician in Kenya, and one of the most frustrating problems I face is the overwhelming numbers of people who just absolutely can not afford health care for their children. The hard part is that the mission hospital is already limping along – charging minimal fees for services. Those minimal fees still amount to $10 a day for an admission plus additional fees for lab services and medications. Parents are so worried about hospital charges that they don’t bring their children in to hospital at all, or if they do bring them it is often in very late stages of illness when appropriate care is decidedly more complicated and expensive than it might have been several days prior.

Our current economic models don’t offer really great solutions to this dilemma. Insurance would perhaps give people a safety net that would bring them in sooner for care, but the national health insurance in Kenya is too expensive for most poor rural families. The only conclusion I can come to is that at least right now, while the general populace in rural western Kenya is so impoverished (we all hope that will change some day), an external source of funds needs to exist to subsidize or pay for health care. The economists among us might disagree but that was the solution I kept bumping up against.

And that idea would stick like a big lump in the back of my throat. My prayers filled with phrases such as, ‘God – I don’t have that kind of money. God – I don’t KNOW anyone with that kind of money. God -- I know I can find money for the 30 or so kids who come to the hospital each month for care now but once this plan works and more children are brought in for care, I’ll be entirely up a creek.’

God fortunately is pretty clear with me in these situations. I sent out an email asking for money for a de-worming program for our kids in Maseno. The response resulted in about five times as much money as I had hoped to raise. I wrote my initial blog describing my frustration at the lack of funds for healthcare. There were additional generous responses with funds sent to Maseno Hospital. Friends from home also offered money to be used as a sort of discretionary fund. Gradually I began to get the idea – our God is a God of abundance. He says, ‘Ask and you shall receive.’

This doesn’t mean don’t be careful with money. I do believe in good stewardship and stretching your every donated Kenyan schilling as far as it will go. But I also am learning that sometimes you have to dream a little bit bigger than you might otherwise be comfortable with. Sometimes you have to have a little faith that God is backing you up and has sent you to this work and will not abandon you.

So I continue to seek that balance between realism and sustainability and faith in God’s wonderful abundance. How else can we move towards God’s Kingdom come? Please keep Kenya in your prayers.

Dr. Christiana Russ is a pediatrician on faculty at Boston Children's Hospital. She spends half the year at an Anglican mission hospital in Kenya through a joint arrangement with Children's and the Diocese of Massachusetts. Christiana is chair of the Executive Council Standing Commission on HIV/AIDS.

Baby Jean (or Why Fee For Service Medical Care Doesn't Work in Poor Communities).

by Dr. Christiana Russ

I work as a pediatrician at Maseno Hospital, an Anglican Mission Hospital in Maseno, Kenya. It sits high up on a hill over the university, and consists of several cream colored buildings with bright blue trim and red roofs. We have a pediatric ward, a male ward, a female ward, maternity, an operating theater, and an outpatient clinic. There is also the Comprehensive Care Center for HIV/AIDS where antiretrovirals are distributed. We have a decent pharmacy and lab, x-ray services and even an ultrasound machine.

Maseno Hospital originally was designed to have approximately 160 beds. During my tenure here, our maximum inpatient census has been approximately 25 patients. This isn't because the communities around Maseno are healthy and well – in fact HIV infection rates are estimated to be approximately 15% for men and over 20% for women aged 15-35. Of all the children born here, approximately 125 out of 1000 won't reach their first birthday and over 200 out of 1000 won't reach their 5th birthday. These numbers used to be much lower, but the HIV pandemic has devastated the young adult population taking away employers and employees and thus further impoverishing the region. HIV has also been taking away mamas and papas, leaving children behind hopefully with extended family, sometimes only older siblings to care for them. The children who die, die mostly of the same diseases that have always killed children who grow up with not enough food and unsanitary conditions. Malaria followed by pneumonia and diarrhea are the primary culprits, all of which are treatable conditions. These children do not receive care for these conditions in this particular area of the world because their families cannot pay for it.

The example of this failed system of care that sits heaviest in my heart is baby Jean – a one month old baby girl seen at Maseno Hospital outpatient clinic one Monday with fevers up to 39 ºC (102 ºF). A lab test revealed elevated white blood cell count; she was fighting an infection. Any small infant with a fever needs to be taken seriously. They often have only subtle signs of bacterial infection and can develop sepsis and die with extraordinary speed if not treated. Baby Jean's mother, however, did not have the deposit for her to be admitted to the hospital so despite the clinical officer's advice that she be admitted, she went home. She was brought back two days later in the evening with difficulty breathing, and was admitted on IV antibiotics and IV fluids.

The following morning she was dead.

This story makes me SO ANGRY. It is an affront to us as human beings that in this day and age it is still possible for a child to not receive appropriate medical care, especially when her mother sought it out. It is an affront to the Anglican church – the entire communion – that we have a cross hanging on the front gate of this hospital and that we don't fund it well enough to take adequate care of those who enter here, even the small children. It is even more damning for us that other organizations are able to find the funds to provide free or highly subsidized care, and we are still operating in a hopelessly un-Christian fee-for-service system. When people don't get basic health care because they can't pay for it, it's a travesty. It's disgusting. It wounds us all.

I am sick at heart today for the children who die due to lack of care, who die within a few miles of institutions such as this hospital which have the capacity to care for them but somehow don't. I am sick at heart for the mothers and fathers, grandparents, and siblings who bury their little ones and know this is not the way it is meant to be. This is not God's plan.

Dr. Christiana Russ is a pediatrician on faculty at Boston Children's Hospital. She is currently working (and spends half the year) at an Anglican mission hospital in Kenya through a joint arrangement with Children's and the Diocese of Massachusetts. Christiana is chair of the Executive Council Standing Commission on HIV/AIDS.

Tomorrow: Josephine Mujawiyera