CRISIS IN THE HORN OF AFRICA - Dr. Bill Frist, former Senate majority leader, telephoned Playbook after returning from a trip with Dr. Jill Biden to a famine refugee camp on the Kenya-Somalia border: "The Horn of Africa is undergoing the most acute food-security emergency in the last 25 years - 29,000 kids have died in the last 90 days. The response to the crisis is improving globally, but the magnitude is outstripped the supplies. ... Two issues that I'm stressing: Number one, lives can be saved by both individual Americans, and taxpayers through our government responding and investing. And, number two, our long-term investments over the last 10 years, through the USAID, in the Horn of Africa, have paid off. ... "Dr. Biden is very effective in listening, observing, listening, asking questions, and representing the United States in terms of concern and commitment of support. Because she's not in the political hotbed, for me, who's out of politics, she was a perfect leader for the delegation. ... I have visited refugee camps in Chad and Darfur ... The striking difference here is the lack of access in Somalia, because of a dysfunctional government. There's no access to the millions of people in Somalia, where the famine is worst. Therefore, the refugees all have to go to Ethiopia and Kenya, where there is economic stress and environmental stress. ... The crowding in the refugee camps has resulted in pneumonia and a very rare skin disorder, ictchyosis. The kids are dying of pneumonia and diarrheal diseases. ... Individuals who do want to invest, the easiest place to go is, which has a list of nongovernment organizations."

kijabe hospital

Photo: Kijabe Hospital

I have been in Kijabe for almost three weeks and today is the first day I received a hard and fast sign that I am in a developing country. No power. No explanation. On one minute then off the next.  It happened in the OR  – just a blink – but serves as a reminder that as much as there is available here in Kijabe, more than in many other hospitals in Kenya, it is still a tenuous resource. One that is dependent on the hard work of so many to keep things running as smoothly as possible so that the lights stay on, the available suture will be strong enough to hold a knot, and blood will be available for the patient with anemia who needs to have his spleen out. 

My first night here I was summoned to “Casualty”, Kijabe’s version of an Emergency Room. There had been an “RTA” (a Road Traffic Accident) and all the victims had been brought to Kijabe. There were 11 total, easily filling the small room that is Casualty. Not quite knowing where to start – which patients had been seen, which had not, I glanced around the room quickly triaging patients. Doing so, I noticed some family members gathered around a stretcher with a young man lying on it. One man in particular looked up from the patient and met my gaze. The look on a trauma family member’s face is unmistakable and is the same no matter where you are from. Grief and sorrow mixed with disbelief and hope - there is hope in there as well. Hope that the news will be good. Hope that the injuries will be minor. Hope that if they are not minor, that their family member will recover quickly and without lasting harm. Hope that you will be able to help. 

I was stopped in the hospital corridor the day following that trauma by that same family member – this family member described the trauma victims as his people. He wanted to thank me for helping his people. He was not satisfied by my simple “you are welcome” but in our mixed conversation of American English, British English, and Swahili I think I managed to convey that it really was my pleasure to be here and to be able to help. 

His cousin in particular was one of the more seriously injured but went home after a few days of monitoring on the wards – grateful to be able to get back to his job and his family. 

This is what Kijabe is able to provide by combining the work of so many – a resource, a place for people to come to heal. A place where it is a true pleasure to be able to help, where one can join with many others to keep the lights on.



by Senator Bill Frist, MD

WHF and Shah

(Senator Frist with USAID Director Dr. Rajiv Shah, 8.7.11)

Yesterday, I visited the Dadaab Refugee Complex in eastern Kenya with Second Lady Dr. Jill Biden and USAID Administrator Rajiv Shah. While there, we heard stories from mothers with their children who had lost their husbands. Families who had journeyed for weeks to arrive at the camp malnourished and in dire need of medical assistance. And, worst of all, parents who had heartbreaking stories of losing children in the flight from famine in Somalia. 

There are two main points, as a doctor and as a former senator, that I want to highlight in the midst of this terrible crisis. 

First, though the United States has provided an enormous contribution of aid (we are providing 47% of the food), we need the help of other nations immediately. The other 53% of funding is being provided by 40 other countries. We need them to step up. We also need private donations to aid agencies as soon as possible. 

For instance, there are over 150 cases of measles, which is huge and can rapidly lead to the death of thousands, in the over-crowded Dadaab camp.  Vaccinations can halt the spread of such fatal diseases.  These children’s health is already severely compromised by malnutrition. Aid agencies need public dollars to fight these diseases, like measles and polio, with vaccinations, oral rehydration, and vitamins, especially in children under the age of five. 

However we do not need to rely on public dollars alone. I have seen firsthand that even the simplest form of aid can save lives and even tiny investments can make a huge impact. A measles vaccination costs under $2 and therapeutic feeding can cost as little as a dollar a day.  A small donation from you can save the life of a child and I am confident that even in our own tough times, Americans will respond generously as they always have when catastrophe strikes around the globe. 

Second, the good news is that we have learned that the famine is not an intractable problem for the region. Though Somalians are having to flee their country and drought is occurring throughout the Horn of Africa, Kenya and Ethiopia are much better prepared to withstand the low rainfall. Our American dollars over the past ten years have paid off. Our investments in agricultural and livestock advancements have prevented the drought from becoming a famine in these two countries. 

The Dadaab camp is a humanitarian crisis and we need your support. Please consider a donation today. We will support those aid agencies who is on the ground providing medical and food assistance to those suffering from the effects of famine. 

Africa: Briefing on Dr. Jill Biden's Recent Visit to Kenya
Tue, 09 Aug 2011 12:50:32 -0500

Briefing on Dr. Jill Biden's Recent Visit to Kenya

Eric P. Schwartz
Assistant Secretary, Bureau of Population, Refugees, and Migration
Senator Bill Frist, and Special Assistant to the President Gayle Smith
Via Teleconference
Washington, DC

August 9, 2011

MR. TONER: Thank you, and thanks to all of you for joining us this morning. As you know, East Africa is facing the worst drought in 60 years, and the UN has declared that famine now affects five regions in Somalia and predicts that it could expand throughout the southern Somalia.

Over the weekend, Dr. Jill Biden led a delegation to Kenya to view firsthand the situation on the ground. And joining us this morning to discuss that trip as well as our overall assistance efforts in the region are several members of the delegation – Special Assistant to the President Gayle Smith, Senator Bill Frist, as well as Assistant Secretary of State for Population, Refugees, and Migration Eric Schwartz.

Just a reminder that this is an on-the-record briefing this morning. And so with that, I’ll hand it over to our first speaker, Gayle Smith.


MS. SMITH: Sure. Thanks, Mark. Good morning, everybody, and thanks for joining us. We were also joined on the trip by USAID Administrator Raj Shah, who is on a plane right now. Otherwise, he’d be on the call with us.

Dr. Biden wanted to do this trip – and thankfully, Senator Frist agreed to join us very early on – to highlight the crisis in the Horn of Africa and basically help mobilize both an American response, but also a global response to a crisis that is acute – I’m sure you’ve all heard the figures of 29,000 kids dying in the last 90 days – but to also underscore the fact that there is a lot we can about it; that we can get assistance to people; that the people in Kenya and Ethiopia, while adversely affected, are in a better position today than they might have been because of things that have been done over the last 10 years; and importantly, that in the long range, we can also support food security.

We visited the Kenyan Agricultural Research Institute, which is supported by the U.S. Government, as a way of highlighting, again, that there are things we can do to reduce the prevalence of famine in the future. We traveled to the Dadaab refugee complex, where Dr. Biden, Senator Frist, and the rest of us were able to both see the relief operations that are going on and meet with many of the Somali refugees that have recently walked to Kenya from inside Somalia.

What we’d like to do this morning is hear from Senator Frist and my colleague Eric Schwartz. I can help address any questions that may come from – for AID given that Raj Shah is unable to be with us. And then we’d like to open up to questions.

So Senator, if I could turn over to you first, and thank you again for joining us on the trip.

SENATOR FRIST: Gayle, thank you. And I’ll be brief. People over the next couple of days are going to ask again and again why in the world did Dr. Biden and all of us take this trip. I went at the invitation of Dr. Biden with a real purpose of helping – in addition to looking to the healthcare needs, which I as a physician do, but really drawing some attention so that the world better understands the size of this catastrophe, the needs, and the fact that in spite of the U.S. stepping up and the world stepping up, the demands and the needs are growing even faster than what is being provided. So it’s not just to learn, but also to help mobilize a domestic response, but also an international response to what a lot of people don’t realize, especially in this environment, of what’s happening in terms of the economy here and at home, but this is the most acute food security emergency anywhere in the world now and in recent years.

As a physician, I did spend time looking at the health and the health needs of the people of the Horn of Africa in part because through our past experiences and as underscored by USAID by focusing on the health needs and therapeutic feeding, we really engage one of the most effective ways of lifting people up in times of need. Food is very important, response in terms of food security, critically important, but the health needs themselves, also very important, and some would even say a prime area of importance.

The crisis is growing fast, and we saw that firsthand on the ground and talking to individual families as they were coming into refugee camps who literally have walked for 15 and 16 days – a mom with her four children, a husband, a father who is absent who is still in Somalia; they don’t know whether or not he’s alive. I think the things we can do is two things – make sure the world knows this is unfolding and know that people’s help and investment, as they have responded in the past here in America, can make a huge, huge difference.

Now with that, I’ll sort of stop because that’s the purpose. Our observations – now it’s up to us to share with the American people and with the world. It’s a nonpartisan issue. I think my presence, in part, demonstrates that. It is everybody coming together in the United States, at a time that many things are very fractured, around a common good and a common cause where past investments have paid off – and we saw that in Kenya, and we saw that in Ethiopia – and where if we continue to invest in the future, we know that these catastrophes don’t reach the threshold that they have today in being one of the great famines of the last 50 years, one of the most tragic famines of the last 50 years.

Now, with that, let me turn to Eric. Again, we had a great team on the ground. We were able to look at these issues from a medical standpoint under Dr. Biden’s leadership putting this team together, under a USAID standpoint, and a State Department and refugee standpoint. With that, let me turn it over to Eric.

ASSISTANT SECRETARY SCHWARTZ: Thank you very much, Senator Frist. And let me also say – join my colleague Gayle in thanking you for your willingness to participate in this trip, and we were honored and extremely – your participation was extremely valuable. We – and let me talk a little bit about Kenya if I may.

The Dadaab refugee complex in the – in northeast Kenya is the host to – was already the host to a very large and protracted refugee population on the order of 300,000 refugees or more. And for that and the management of that relief effort over many, many years and the assistance of the management, we’re very grateful to the Government of Kenya that has provided refuge to Somalis.

But what they’ve seen in recent months is an enormous increase in the numbers. Right now, the numbers of refugees in the Dadaab complex is estimated at over 420,000. There are probably about 477,000 Somalis in camps throughout Kenya, but in Dadaab it’s well over 420,000. The refugees from Somalia are coming in at a rate of late of about 1,400 to 1,800 per day, although that number obviously changes as the situation changes. And the challenges are substantial. People are coming in in very, very difficult conditions. The rates of malnutrition are very, very high. It has severely taxed the registration capabilities in the camps.

At the same time, it’s very important to note that the Somalis who are coming in with all of those difficulties are receiving basic food and sustenance when they get in to the camps and that the United Nations is hard at work with the involvement and support of the Government of Kenya on the expansion of this facility. There are three camps in the Dadaab complex, and one of those camps is being expanded substantially. In addition, they’re building a fourth facility as well. So efforts are hard – are underway and are moving forward in terms of expanding the capability of the camps to handle this inflow of Somalis.

Similarly, we are making substantial efforts to provide assistant to the Government of Ethiopia, which is providing about – assistance to about 160,000 Somali refugees, as well as our efforts to provide assistance to those areas within Somalia which we can reach with assistance. So the effort is full on and will continue in the days and weeks and months to come.

The visit, I think, was important in terms of shedding light on the important efforts that are underway and the importance of continued support from the international community. With that, I guess I’ll turn it back either to Gayle or to Mark. I don’t know who our moderator is right now.

MR. TONER: Great. Thanks, Eric. Mark here. Thank you all. And, operator, we’re ready to open it up to questions now. Again, just a reminder this is an on-the-record briefing, and if you could just state your name and media affiliation, that would be a big help.


OPERATOR: Thank you. We will now begin the question-and-answer session. If you would like to ask a question, please press *1. To withdraw your request, press *2. Once again, if you would like to ask a question, please press *1. One moment, please, for the first question.

Our first question comes from Mina al-Oraibi. Your line is open.

QUESTION: Good morning. I’m with Asharq Alawsat newspaper, Arabic language paper. Thanks for doing this. I wanted to ask you in terms of international response, I know there is a UN appeal out at the moment, but if you could speak a little more about what can be done on an international scale to support those in Somalia but also those in Ethiopia and Kenya.

MS. SMITH: Sure, I’m happy to take a first cut at this. Eric, you may want to add. This is Gayle Smith.

The UN has issued an appeal, but the biggest need, quite frankly, right now is for cash contributions. That enables folks on the ground, both UN agencies and NGOs, to provide whatever may be needed the most effectively, whether it is food, whether it’s therapeutic feeding, whether it’s access to water and so on.

We’re seeing already, although the response is not as large as it needs to be to keep up with the spread of famine in Somalia and ensure that we are able to prevent conditions from getting worse in Ethiopia or for Kenyans in Kenya and to manage the refugee flow, there are donors contributing from all over the world. But what we need really from everybody is to increase those donations as quickly as possible, again, so we can keep pace.

Eric, do you want to say something about the appeal itself?

ASSISTANT SECRETARY SCHWARTZ: Well, the appeal is – the United States has been a generous contributor to the international appeal. It’s an appeal – a multi-donor agency appeal. I don’t have the specific figures of how much of the appeal has been subscribed, but we’re – but at this point, we’re calling on other governments to really kind of step up to the plate here and give generously to all of the UN agencies.

But a number of the UN agencies also accept contributions from the public, such as UNICEF and others, and contributions from the public in these kinds of situations can be extremely valuable. The nongovernmental community, I should say for example, in the tsunami response a couple of years ago, of the entire amount that was contributed, about 5 billion of the 13 billion that was spent on the tsunami response came from the nongovernmental community supported by private donations. So the role for private donors can be quite substantial in these circumstances.

SENATOR FRIST: Eric, let me pick up on that just a little bit, though the question is really about the international community, only because I’m totally in the private sector now and this is important, especially for everybody on the call. There’s a great need. All of you know that. The data is there. We saw it. The big thing that I want to share with people is that everybody can make a difference, not just the governments per se. And we saw firsthand over the last 36 hours, just how effective these donations can be to improving health and literally, literally saving lives.

People say, well, where to go, and the easiest thing to do is to send people to, In there, on the website, there’s a listing of all the nongovernment organizations, many of whom we saw on the ground working side-by-side in partnership with governments. We really do hope speaking here at home, or I hope and what I really want to be stressing, is that we know that Americans act – we’ve seen it in the past, we saw it at the tsunami, we saw it at the tragedy in Haiti – and to really do what they always do to help those in need. And the big thing is these tiny donations can make a huge difference. And again, the easiest site is the USAID site because they’ve taken the time to put a lot of the nongovernment organizations that we depend on, and you can see which organizations are doing this sort of work.

So yes, the government is important. The support for our past investments we saw firsthand at the agricultural center, but also individual donations to these sites saves lives.

MR. TONER: Thank you. I think we’re ready for our next question.

OPERATOR: Thank you. The next question comes from Lachlan Carmichael. Your line is open.

QUESTION: Hi. Yes, as far as Kenya is concerned, do you think the Kenyan authorities are measuring up to the scale of the disaster facing them in their own country? I mean, the government spokesman said, I think just last month, that not one Kenyan had died of – as a result of hunger. And apparently, there are harvests in parts of the country that are good but nothing distributed to the areas hit by famine.

MS. SMITH: Let me just say something about that. That’s a – it’s a good question. I think one of the very good things we’re seeing, although obviously more can be done, is that for Ethiopians in Ethiopian and Kenyans in Kenya, as Dr. Frist said, there are a lot of things being done to assist them because they can be reached. Now, there’s more that can be done to make sure that grain stocks available in the region are more accessible and can be moved more freely. We and others are working on that with those two governments to make sure that where food stocks are available, they can be purchased and moved to people who need them.

I think that what we’re seeing – and again, I want to be careful here – is that we don’t have enough assistance even for the people of Ethiopia and Kenya that are affected. But in those cases, for two reasons, we’ve got a slightly better shot than we do with the difficulties we face in Somalia. The first, as Dr. Frist said, is some of the programs that have been put in place by USAID, by other donors, by those governments, to make sure those people are less vulnerable to droughts of this scale. And the second is, again, because they are accessible.

So I can’t answer to whether a single person has died or not. I do think that what we’ve got there is a case that with sufficient assistance, with the agility of those markets to which you point, we really can help get these people through a very bad year of drought and to the next set of rains.

ASSISTANT SECRETARY SCHWARTZ: If I can just comment on a question that – on a question, actually, that perhaps wasn’t asked but is related in terms of the government’s response with respect to the refugee situation, I think we have to give the Government of Kenya substantial credit for its willingness to continue to provide first asylum to this population. After all, if you just take the population of the refugee camps in the Dadaab area, you’re talking about one percent of the entire population of Kenya. And so for the Government of Kenya to continue to provide refuge, as it certainly should – but for the government to continue to do this, I think is – the United States is very appreciative of these efforts and that is why we are doing everything we can to assist the government in its efforts to continue to stay the course on this.

MR. TONER: Thank you. I think we’re ready for our next question.

OPERATOR: Thank you. Our next question comes from Carmen Russell. Your line is open.

QUESTION: Hello? Hi. Sorry. My question is where exactly is the U.S. aid going? Are we able – I mean, how well are we able to track this? How likely is it that the U.S. itself will step up its contributions as the situation gets worse? And what other political action is the U.S. willing to take?

MS. SMITH: We announced yesterday an additional contribution of $105 million to the regional relief effort, including both people who are affected in their own countries and to the refugee effort, bringing us up to over $560 million. We are the lead donor. But importantly there, we will continue to support the relief effort, but we are also aggressively reaching out to other countries because this is of a scale that we certainly can’t do it alone. We need other countries to step up with us. And I think, as I said earlier, we are seeing that other countries are responding. But part of our mission is both, as I say, to respond but also to reach out and use our position as the United States to encourage other donors to ramp up their responses. So we’re certainly willing to keep doing that, and that’s our intention.

MR. TONER: All right. Thank you. I think we’re ready for our next question.

OPERATOR: Thank you. Our next question is from Michele Kelemen. Your line is open.

QUESTION: Yeah, hi. I was wondering – the al-Shabaab pullout of Mogadishu, whether that’s made any difference for access there, and whether you’ve seen any aid agencies taking up your offer to ease restrictions on going into the south of Sudan – Somalia.

MS. SMITH: Again, I’m happy to take this and have others amplify. Hi, Michele.

The move of al-Shabaab out of Mogadishu is a good sign. It’s too early to tell whether it is a good and lasting sign, but it does offer the possibility of getting more assistance in through Mogadishu and to assist people there, because one of the things we’ve seen is the congregation of internally displaced people as Somalis move into Mogadishu in search of assistance.

There are agencies that are moving in to take advantage of that opening. One of the things that we’re very mindful of here is that we want to make sure that NGOs and UN agencies and others that are trying to provide assistance are able to do so in the utmost security, so I’m inclined to be a little bit careful about exactly who is doing what. But one of the very good things we have on hand is some of the most seasoned humanitarian operators in the world, given the complexity of this environment, and they are moving very swiftly to seize every opening that they can possibly have.

USAID is engaged with a number of nongovernmental organizations from around the world, and particularly American NGOs who are looking to ramp up their assistance and are doing that right now. So we are seeing a really, really good response from, as I say, UN agencies, international organizations, and NGOs who are poised and, with our assistance, trying to access every bit that they can as the situation unfolds.

QUESTION: If I could ask just one other question about the aid money that was announced yesterday --

MS. SMITH: Mm-hmm.

QUESTION: Is that specifically going to any country? Is it going mainly to Kenya --

MS. SMITH: Yeah.

QUESTION: -- and Ethiopia or is going into --

MS. SMITH: We can get you a breakdown of that. USAID issued a fact sheet last night, and if you need more information, we’d be happy if you want to check back with Mark. Mark can direct you to one of us who can get you the exact breakdown. But that assistance covers the full range of things for the people of Kenya and Ethiopia, for assistance inside Somalia, and also and importantly, for refugees in both Kenya and Ethiopia, so it’s part of a comprehensive response. But we can get you the specific breakdown after the call if you’d like it.

QUESTION: Great. Thanks, Gayle.

MR. TONER: Yeah. We’ll make sure that we push that out to folks.

Great. Next question?

OPERATOR: At this time, there are no further questions.

MR. TONER: Great. Well, okay, very good, then. Well, I just want to thank all the journalists who joined us this morning and especially thank all of our participants for taking time out to talk about this important issue, and to discuss the trip. So thanks to all of you again and have a very good day.

MS. SMITH: Thank you.


From Dadaab Refuge Complex

WHF and Biden 8.8.11

This week I traveled with Second Lady Dr. Jill Biden to refugee camps in eastern Kenya along the Somali border to witness the impact of the most acute food security emergency on earth. We need your help, and your help I promise will make a difference.
Yesterday we visited intake centers just on the border where over 1,500 Somalis who walked for weeks with their starving children (over 29,000 young children have died of malnutrition and disease in Somalia alone over the past 90 days) arrive each day to find food and a safe place to live. But the camps are at capacity (the Dadaab camp has 430,000 refugees today; it was designed for 90,000) and new arrivals are left to fend for themselves on the outskirts of the camp.

Over the years I have delivered medical care in refugee camps on a number of trips, to camps in Darfur, Chad (on the border of Sudan), and in boy soldier camps in southern Sudan. I go as a doctor – and an observer of how we as individuals back at home can make a difference. Providing age appropriate health care to the vulnerable and malnourished children and adults is crucial to combat rapidly spreading disease and death. I see how we can use medicine and health as a currency for security and peace.

At Dadaab, I met with the nurses and doctors in clinics closed to the press.  Vaccinations for measles and polio are in need. The crowded conditions in the camps make the kids especially susceptible to these deadly infectious diseases. That’s why we are seeing the current outbreaks of measles in the camps. Measles are  preventable and treatable but we need more help. And that is where each of us comes in.

I saw the miracle of inexpensive oral rehydration with nutrients for babies and children who would otherwise die from the common diarrheal diseases that come from malnutrition. Much needed vitamins bolster the children’s immune systems. These are all simple, cheap interventions that are needed today.  And they are all within our reach to provide.

The American people have done and are doing a lot (we are contributing over 47% of the current food aid coming to the Horn of Africa) which has markedly lessened the unfolding tragedy in the region, but the need today is growing faster than we and the entire international community are responding.

Dr. Biden and I, accompanied by USAID administrator Rajiv Shah, also saw in the field how our nation’s past investments are paying off. Due to our country’s investments in agricultural and livestock advancements in Kenya and Ethiopia over the past decade, they are able to handle the drought without the death associated with famine. But, lacking these investments over the past decade in war-torn Somalia, thousands have died and millions are at risk.

Aid agencies estimate that over $1 billion more is needed during this critical period to stop further deaths and get proper food, water, and health care, especially to the children who are most vulnerable.

How can you help? Hope Through Healing Hands is launching an East Africa Famine Campaign to raise funds to provide assistance to aid agencies who are on the ground now in the Horn of Africa. Based on my personal experiences, we will select beneficiaries whom we know and trust, who are on the ground now delivering care, and who will be providing both food and medical care to the victims of the famine.
Over 12 million are being affected. They need your support today.

We need your help,

Bill Frist Signature 
Bill Frist, MD

P.S. Please follow our blog and Facebook updates for more on the East Africa Famine Crisis.

Sunday, August 7, 2011

By Senator Bill Frist, MD
Chair, Hope Through Healing Hands

WHF and Biden 8.8.11

(WHF and Dr. Biden: 8.8.11)

Over 29,000 young children have died of malnutrition and disease in Somalia over the past 90 days. We are now on our way to the Horn of Africa to see what more we as a nation can do.

Early this morning, our plane left Washington DC bound for East Africa. I’m flying with Second Lady Dr. Jill Biden and USAID Administrator Raj Shah to study the famine affecting the lives of over 12 million people, many of them children.

In fact, it is now being called “The Children’s Famine.” 

Over the years, I have delivered medical care in refugee camps on a number of trips, both to camps in Darfur, in Chad (right on the border of Sudan), and in boy soldier camps in southern Sudan.  I went as a doctor. Providing age appropriate health care to the compromised and malnourished children and adults is crucial to combat rapidly spreading disease and death.

It begins with identifying the specific needs, which we will be doing, then ensuring access, which is a challenge especially in Somalia.

Aid agencies estimate that over $1 billion more is needed during this critical period to stop further deaths and get proper food, water, and health care especially to the children who are most vulnerable.

In the camps we visit, I will focus on the vaccinations given for measles, polio, and malaria; oral rehydration distributed to those suffering from diarrhea; and, vitamins for children to bolster their immune systems. These are simple, cheap interventions to fight disease in the malnourished.  I am eager to learn what is being accomplished and what more needs to be done.  America has done a lot which has lessened the unfolding tragedy in the region, but there is a lot more we can do to reverse the course underway.

We will learn much over the next few days.

I am on this trip to hear the stories of the families and their journeys, and I will share those stories with you. 

Please sign the ONE petition today to urge world leaders to provide the full funding that the UN has identified as necessary to help people in the Horn of Africa, and please keep your promises to deliver the long term solutions which could prevent crises like this from happening again.


megan quinn 4

When thinking about public health in the developed world, we generally think about preventing chronic disease through behavior change.  However, in Mshenguville (the informal settlement/shack town in Munsieville), the public health needs are drastically different and much more basic.  One of the key issues in Mshenguville is the need for basic sanitation/waste management.  Illegal dumping around various sites in Mshenguville occurs because people do not think that there other alternatives and do not understand the consequences of poor sanitation. 

One particular dumping site is around the community water tap.  While this tap provides safe, clean drinking water, the environment surrounding it is ripe with health hazards.  The tap is surrounded by waste, including diapers, clothes, and general rubbish and serves as a food source for chickens and dogs.  Further, the tap does not have proper drainage and therefore provides a nice source of stagnant water for insects to breed in.  Luckily, malaria is not a major issue in this area due to the high altitude, however; other vector borne illnesses could potentially have high infectious rates during the warm summer months.  Not surprisingly, local have identified diarrheal diseases as a concern in this area of Munsieville.  Poor sanitation in this community elevates the risk for infectious disease, specifically in the vulnerable populations: children and the elderly.

With the assistance of the Councillor for this ward of Munsieville, Thapi Thage, and the local Community Work Program, we completed a community clean-up in this part of Munsieville on Tuesday July 26th.  Over thirty people assisted in the clean-up and these efforts could aid over 250 people that live in Mshenguville.  However, the clean-up only served as a preliminary effort as we were not able to completely clean the entire area due to the immense amount of rubbish.  We need additional long-term, sustainable solutions to aid in providing proper sanitation and waste management to this community. 

Feedback from one of the focus groups we conducted with the children earlier this summer will be utilized to provide some solutions to this public health issue.  The children independently identified illegal dumping as a health related issue in their community.  The following solutions were listed: put a billboard up to signify “no dumping” in that area, put rubbish bins all over Munsieville, form a community worker program, provide a billboard that lists the rules of waste disposal and teaches people to take care of their community, require people to pay for the damage they are causing to their community.

Project Hope UK/The Thoughtful Path will continue working with Thapi and the municipality government to employ the solutions the children listed and provide the appropriate resources for proper waste disposal, including: trash bins for every household, community dumpster, and trash pick-up by the local waste management services.  Finally, community meetings in Mshenguville will be held to provide general education on waste disposal and the burden of disease due to improper sanitation, assess the community needs for proper waste disposal, and the barriers to effectively disposing waste.  Hopefully these efforts will provide a safe, healthy community and create a sense of pride for the people of Mshenguville and the overall Munsieville public.  Providing the basic public health needs in this community will effectively prevent infectious disease and reduce the morbidity and mortality of sanitation related diseases in vulnerable populations.      

by Jenny Eaton Dyer, Ph.D.

The numbers are staggering. Over 12 million people are reported to be in dire need of food and clean water. And more continue to trickle in daily to the refugee camps. Somalia has seen famines before, but this is said to be the worst. Perhaps the greatest crisis of the decade.

Today, Mohammad Ibrahim writes about the emergency in the NYT, "Somalis Waste Away as Insurgents Block Escape from Famine."

It is an extremely complex and difficult situation. Aid agencies are having trouble getting into and providing care for the most vunerable. Governmental funding is especially and desperately needed to avert the loss of millions of lives. 

How can you help? For starters, support Save the Children.

East Africa Drought and Food Crisis: A dollar a day for 100 days can help us keep a child alive. Give online at or text "SURVIVE" to 20222 to donate $10 (Standard message rates apply)

Recommended Reading: "Global Food Crisis Takes Heavy Toll in East Africa," by Samuel Loewenberg, in The Lancet.

omo 1

We had orthopedic clinic today. Many of our adult patients presented with fractures secondary to road traffic accidents. The pediatric cases were more varied. Some of the patients seen included:

  1. 2yo with hereditary neurofibromatosis; over here, neurofibromatosis is diagnosed clinically. The diagnostic criteria are the presence of two or more of the following: 1. six or more café-au-lait spots 5mm or greater in diameter; 2. freckling in the armpit or groin; 3. two or more neurofibromas of any type or one plexiform neurofibroma; 4. two or more Lisch nodules; 5. optic glioma; 6. distinctive bone lesions, particularly an abnormally formed sphenoid bone or tibial pseudoarthrosis; and 7. a first-degree relative diagnosed with neurofibromatosis using the above criteria. This two year old has several café-au-lait spots along with left leg hypertrophy, with left long being longer and wider than the right, due to both bone (femur, tibia and fibular) and soft tissue hypertrophy. She also has a lower limb deformity, genu valgus, which we plan to correct at a later date. Her mom has several café-au-lait spots (but no limb abnormalities) and her 5yo older sister has no café-au-lait spots, but hypertrophic left hand digits and left toes. Her mom and sister did not carry official neurofibromatosis diagnoses, but do now since she clearly has neurofibromatosis based on clinical criteria. Genetic tests are not readily available, but this is a classic example of variable expression routinely observed in autosomal dominant neurofibromatosis.
  1. 4yo with club foot secondary to polio; we did her corrective surgery today. The surgery was interesting. First, we did an ETA (elongation of the tendo-achilles), in which the calcaneal (Achilles) tendon was identified and bisected in a Z configuration, then re-attached. Then, the bursa deep to the calceneal tendon was ruptured. Finally, a wedge resection of the cuboid was performed. Pins were placed to close the resected segment; subcutaneous tissue and skin were closed, and the foot was placed in a cast to help set it in the proper configuration.
  1. 2yo M with bowed legs (bilateral genu varus). The big thing was to rule out Ricketts. This was assessed by checking for costochondrial rosary beading, wrist flaring and forehead bossing. The plan is to have him follow up in 6months. Follow up involves regular measurement of the intercondylar distance and varus angle; expect correction in physiological bowing. The orthopedic surgeons here have observed that an intercondylar distance <9cm is likely to correct itself with time; >9cm often needs to be surgically corrected.
  1. 14yo with Blount’s disease (pathological bowing). She had very bowed legs that had been surgically corrected two other times in childhood, but became bowed as she grew. Plan is for one more correction in a year or so; she’s likely stopped growing and would no longer need corrections after this one.
  1. 6yo with physiologic genu valgus expected to correct on its own with time; for valgus, the follow up is of the inter malleolar distance and valgus angle.
  1. 2yo with foot drop and high stepping gait secondary to IM injection that caused damaged to the common peroneal branch of her sciatic nerve. Plan is for long-term physiotherapy and toe-raising splint.
  1. 3mo with osteogenesis imperfecta which was clinically diagnosed on basis of neonatal femoral and tibial fractures as well as the presence of bluish sclera (she was compared to her healthy twin). This was quite interesting to me as I did not expect to see a child with OI in Nigeria. Anyway, the plan is to treat her fractures as they occur; babies with her type of OI (OI type I, not type II, which is so severe the babies die following the trauma of birth) usually do well as they learn to avoid doing things that will cause them injury.
  1. 14yo with congenital absence of the R. proximal femur that walks by bending her left leg to compensate for the very short right leg; she appears to be kneeling/crawling as she walks, but she’s able to stand upright on the L. leg. The correction would be to amputate the R. lower limb and place a prosthetic; she does not want this.
  1. Neonate with bilateral club foot due to congenital bilateral absent fibulas. We placed casts to begin serially correcting the clubbing.
  1. 28yo with remote history of ectopic pregnancy, presented with bilateral hip pain. X-ray showed bilateral cystic lesions at the femoral head and narrowed interarticular space. We did a TB skin test (which is non-specific in this population exposed to BCG vaccine, but the more specific IFN-gamma release assay is also considerably more expensive), also sent her for HIV testing and her blood group was checked because people with sickle cell disease are prone to avascular necrosis of the hip (she’s AA). I think, given her h/o ectopic pregnancy, there is a likelihood of gonorrhea/chlamydia exposure and possibility of septic arthritis from gonococcus; but this would be an atypical presentation.

Later in the day, I attended morbidity and mortalilty conference where I learned that the most common admissions on the medicine service are due to cardiovascular/ cerebrovascular diseases and CHF; not infectious diseases though, in the month of July, one patient died of malaria and another of AIDS. Another thing that was interesting to note is that for some patients, cause of death ends up being undetermined. E.g. the case presented of a man who presumptively died of hypoglycemia secondary to metastatic liver cancer; assumed to have liver cancer because his liver enzymes were elevated and he had a bone tumor. However, he was initially diagnosed with bone TB in the ortho clinic, but did not receive TB treatment (again, here, TB diagnosis is non-specific due to BCG vaccination). He never had any scans to show or disprove liver tumor and did not have an autopsy at death. All we know is that he came to the hospital with hypoglycemia and his labs showed elevated liver enzymes. There is a need for better access to pathology.


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