From atop the luggage in the back of Gosperth’s land rover, it was hard to tell whether we drove 70 km off the beaten path into Masai territory, or if we just spent 3 hours making sharp turns to hit landmines in the middle of a duststorm. The only living things we saw for the better part of the last hour were herds of goats, men in traditional Masai gear riding motorcycles (to herd the goats?), and the infamous “brown zebra” (donkey).
After lunch, we spent around four hours at the clinic, which Michelle described in full, and went back to the camp. On the walk, we terrified groups of Masai children, who are apparantly told the mzungu eat African children in their sleep. Naturally, we chased them, which made their traditional robes transform into capes flying on otherwise naked children. We then made up for it by playing soccer with a ball made out of plastic bags and passing out toy cars and (sorry, dentists) candy. At our base, rooms were arranged in a mini-hostel format, with an open kitchen (food over coal pits),and a central patio.
Gladness, our hostess, cannot be described accurately with words. She started a business with Masai women to allow them to sell crafts and gain some independent income and runs the hostel when visitors come to Lengast. Gladness spent most of our visit running around camp yelling “goodi goodi” and “food is ready- KARIBU (welcome).” Gladness drank 3 local brews and told us about drinking “the ‘kila” which made her “so warm… first the shirt comes off, then the pants, then I am dancing in the ocean- whoosh!” Gladness taught us to “shake the taco,” and created songs to commemorate most of the simple actions of the evening. She is likely my favorite Tanzanian.
We awoke the next morning and spent the better part of the day in clinic, topping us off at over 250 patients seen. After lunch, we somehow found ourselves with 7 other Tanzanians in the back of a pickup truck, speeding through dust storms on our way to the “biggest mountain in Lengast.” Though the title of “mountain” may have been slightly exaggerated, it did yield the most incredible view and spoke to the absolute isolation of the clinic. Pictures don’t do the view justice; it was breathtaking. Plus, the rocks looked just like the opening scene of the Lion King, which was pretty sweet.
When we got back, we learned that the Masai had, in fact, slaughtered a goat for our arrival. We also learned that they do, in fact, eat ALL of the goat. Meat was leaned over the fire on sticks, and more than one of us was chased around the commons by Gladness and goat testicles on a stick. We all ended up sampling the delicacies.
We spent the better part of the next hour playing with Masai children- taking pictures and showing them the images on digital cameras, dancing, running. They are both endlessly amused with the mzungu and absolutely terrified.
After dinner-fire came Masai courtship dance, during which we all may or may not have become engaged to several eligible Masai bachelors. The men and women line up across from one another. In a call-and-response kind of format, the men and women sing back and forth. One at a time, a girl would run out and shake all the beaded/metal jewelry on herself without really appearing to move her body. She then apparantly touches shoulders with a man and runs back to the crowd. And the process is repeated. Sometimes a man and woman dance in the same fashion in the middle of the crowd. Sometimes the men jump out of line and run at the women’s line. Sometimes the men have what appear to be jumping contests. Sometimes the white mzungu are forced to run to the middle even when they have no idea what is going on.
Somewhere in the midst of dancing and goat-eating, we were given copious amounts of nailpolish remover to drink, which the locals claimed was some kind of homemade Konyagi (Tanzanian moonshine). It was awful and I will say no more.
At breakfast, Gladness handed me a piece of meat and told me “give this to Blian… it is the exhaust end.” At which point I realized she had just handed me goat rectum/anus. Which seems like an appropriate end to the Masai villiage story.
Sunday, July 26, 2009
A Weekend in the Maasai Clinic: July 24-26th
In the last few days in Lengast we did a two day free childrens clinic … well, mostly children. A lot of moms and grandmas and random old men wanted to be seen as well and we just couldn’t turn them away! We were Dr. Harry, Dr. Lint/Lindsley, Dr. Michelle, Dr. Blad, Dr. Brian/Brianna. (Brad and Brian are a medical assistant and a doctor that we met up with from Salem at Mt. Meru). We had three separate exam rooms set up and from 1-10 patients. Very often moms would walk in with 4 or 5 kids with medical problems, as well as a complaint themselves. And often times the kids had very different diagnoses. The medical students saw patients ourselves, examined them, developed a treatment plan and called in Dr. Brian when we felt necessary. In all we saw 250 patients in 2 days (10 hours). We worked through interpreters … some of them were great, and some of them not-so-much.
We saw a lot of Pneumonia, Malaria, Intestional Worms, and Fungal Skin infections, but we also saw some really interesting patients that we had not yet seen in the states:
1) Molluscum Contagiosum: Dr. Harry saw this patient with assistance from Dr. Brian, and it really looks like small pox. Shout to to Med12 … you remember this one from BBOD? Only surviving pox virus!
2) On Saturday morning, all of Harry’s patients seemed to be geriatric. She saw a lot of “My joints hurt” and “I can’t see well” and “I’m tired all the time.” Sounds a lot like our grandparents back in the states!
3) Michelle saw a patient who complained of bilateral ear pain. So I looked in his left ear and saw his TM perforated (definitely not the first time today) and then I looked in his right ear and saw some black and red things, which I couldn’t really differentiate. It kind of looked like a bug to me, so I called in Dr. Brian. He then asks mom through an interpreter “did he stick anything in his ear?” to which the mom responded “oh yeah, he stuck a stick in his ear the other day.” Through several saline washes and forcep excision from the ear, Dr. Brian and I pulled out a 1cm x 0.5 cm stick and pebbles from this kids ear. And he didn’t even scream at all, just winced a little bit.
4) Dr. Lindslay saw a kid with malformed limbs who wanted an mzungu (white person) opinion. This six month old girl had limbs that were malformed, and she had blue sclera and dysmorphic facial features. Med12? Diagnose the patient …. Osteogenesis Imperfecta!
5) Lindsay drained her first abscess from the neck of a 12 year old. In Lindslay’s words … “it was magical!” It drained beautifully … blood and pus just oozed out. In Dr. Brad’s words … “it was awesome!”
6) Mzunguphobia was also a very common diagnosis. When the moms pulled out their little toddlers from beneath their kangas (moms often carry their kids on their backs beneath a kanga) the kids immediately started screaming at the sight of a white person. Some of these kids have never seen a white person, and the sight of us was just terrifying!
7) The mzungu touch was also a common request. There were lots of moms that brought in their perfectly healthy kids for a “white person touch.” One of Michelle’s patients was a 6 month old girl with thunder thighs … the only kid in this country that I have seen with thunder thighs! And mom’s concern was “is she developing properly?” Yes … she is the healthiest kid we have seen in Africa so far.
8) Many moms walked into the clinic and told us that “it hurts when the dust gets in the kids eyes.” Hmmm …. I think that I have the same problem! Yeah, it really hurts when dust gets in my eyes too!
We saw a lot of kids with “pneumonia” which we diagnosed simply clinically. A lot of these kids probably had a viral URI, but since it was a short-term clinic with no follow-up the best solution was to treat them. We gave a lot of amoxicillin, I mean a ton of amoxicillin to treat “pneumonia.” Most of their lungs sounded really crappy, but we weren’t exactly positive that it was “pneumonia” instead of a viral URI. I think that we just created amoxicillin resistance in Tanzania.
One of our nurses was named “Candida.” Med12 … I’m not kidding you … her name was Candida, and it was really hard to leave the “albicans” off of that.
Overall the clinic was a lot of fun, we helped lots of kids. We did end up seeing some pretty sick patients … TB, Congenital heart disease, and the like … and we helped a lot of patients that would otherwise have not received medical care.
We saw a lot of Pneumonia, Malaria, Intestional Worms, and Fungal Skin infections, but we also saw some really interesting patients that we had not yet seen in the states:
1) Molluscum Contagiosum: Dr. Harry saw this patient with assistance from Dr. Brian, and it really looks like small pox. Shout to to Med12 … you remember this one from BBOD? Only surviving pox virus!
2) On Saturday morning, all of Harry’s patients seemed to be geriatric. She saw a lot of “My joints hurt” and “I can’t see well” and “I’m tired all the time.” Sounds a lot like our grandparents back in the states!
3) Michelle saw a patient who complained of bilateral ear pain. So I looked in his left ear and saw his TM perforated (definitely not the first time today) and then I looked in his right ear and saw some black and red things, which I couldn’t really differentiate. It kind of looked like a bug to me, so I called in Dr. Brian. He then asks mom through an interpreter “did he stick anything in his ear?” to which the mom responded “oh yeah, he stuck a stick in his ear the other day.” Through several saline washes and forcep excision from the ear, Dr. Brian and I pulled out a 1cm x 0.5 cm stick and pebbles from this kids ear. And he didn’t even scream at all, just winced a little bit.
4) Dr. Lindslay saw a kid with malformed limbs who wanted an mzungu (white person) opinion. This six month old girl had limbs that were malformed, and she had blue sclera and dysmorphic facial features. Med12? Diagnose the patient …. Osteogenesis Imperfecta!
5) Lindsay drained her first abscess from the neck of a 12 year old. In Lindslay’s words … “it was magical!” It drained beautifully … blood and pus just oozed out. In Dr. Brad’s words … “it was awesome!”
6) Mzunguphobia was also a very common diagnosis. When the moms pulled out their little toddlers from beneath their kangas (moms often carry their kids on their backs beneath a kanga) the kids immediately started screaming at the sight of a white person. Some of these kids have never seen a white person, and the sight of us was just terrifying!
7) The mzungu touch was also a common request. There were lots of moms that brought in their perfectly healthy kids for a “white person touch.” One of Michelle’s patients was a 6 month old girl with thunder thighs … the only kid in this country that I have seen with thunder thighs! And mom’s concern was “is she developing properly?” Yes … she is the healthiest kid we have seen in Africa so far.
8) Many moms walked into the clinic and told us that “it hurts when the dust gets in the kids eyes.” Hmmm …. I think that I have the same problem! Yeah, it really hurts when dust gets in my eyes too!
We saw a lot of kids with “pneumonia” which we diagnosed simply clinically. A lot of these kids probably had a viral URI, but since it was a short-term clinic with no follow-up the best solution was to treat them. We gave a lot of amoxicillin, I mean a ton of amoxicillin to treat “pneumonia.” Most of their lungs sounded really crappy, but we weren’t exactly positive that it was “pneumonia” instead of a viral URI. I think that we just created amoxicillin resistance in Tanzania.
One of our nurses was named “Candida.” Med12 … I’m not kidding you … her name was Candida, and it was really hard to leave the “albicans” off of that.
Overall the clinic was a lot of fun, we helped lots of kids. We did end up seeing some pretty sick patients … TB, Congenital heart disease, and the like … and we helped a lot of patients that would otherwise have not received medical care.
July 18th: Arusha National Park!
July 18th: Arusha National Park!
Today we went to Arusha National Park- our first mini-safari. We got up at 5 in the morning and got ready to head out around six to catch a bus- then we realized the sun doesn’t actually start rising until 6:30 and we weren’t about to wander around in the dark. So we waited anxiously for a half hour, drinking delicous African tea. We made it to the bus station around 7 and got haggled and haggled like we never have before! “Nairobi!” “Moshi” “Dar es Salaam!” “Follow me ladies, I take you to Nairobi.” My personal favorite haggle technique--- calling us by some random white girl name and hoping we’ll respond. “Jessica! Jessica this way!” So funny.
We found a bus to Moshi, and had to haggle back with the bus driver to get him to drop us off at Usa River where the turn for the park is. We hit the road, went two hundred yards, and the bus broke down. They worked on it for about fifteen minutes and got it running again, and we set off on the bumpiest ride on the most miserable road ever. We got off at Usa River and got hounded by taxi drivers, but our finely-honed negotiating skills got us a decent fare with a friendly driver. We reached the first gate at the park and hit another setback- it was going to cost us $35 each to get in the park, and they were going to charge us to get the taxi in to drop us off at the second, real park gate. It can be really frustrating here to pay for all the incidental fees for tourists. Tanzanians pay about $2 to visit the park. This is a good thing, because all the locals should be able to afford to see the incredible things that are here in this country- but the kicker is that they charge tourists in US dollars. US dollars are difficult to come by here- you have to withdraw from the ATM in shillings and then pay a high changing fee. Why US dollars? The currency of the country is shillings. It’s a real pain. Luckily, the park is one of the few places that accepts credit card so we were okay. Still- an extra $12 just to let the taxi driver drop us off at the main gate—grrr.
About two km outside the main gate, we came around the corner to find a herd of about sixty zebra. ZEBRA! This had us all freaking out and all the troubles of the morning were forgotten. The taxi driver stopped so we could freak out properly, and we kept driving. A few turns later we came across a family of baboons sitting in the road- a about six adults and a few little ones and two very tiny ones. They looked at us and kind of moved slowly out of the way- they’ve seen cars before.
When we got to the main gate at the park we arranged for a four hour walking safari- we found another student tourist to join our group. His name is Till, from Germany here for an internship. Anyway the four of us were accompanied by a guide, a tiny woman named Hawa who carried a gun that was nearly as tall as she was. She wore green khaki fatigues, a safari hat, and an easy smile. She brought us out on a long path through a green grassland where we saw a group of buffalo and warthogs grazing together. The warthogs live with the buffalo because the buffalo are big and scary, and the buffalo appreciate the warthogs’ keen eyesight- at the sight of a predator the warthogs take of running with their tails up like antennae, signaling the alarm.
We saw a pair of dik-diks in the bush. Dik-diks are really tiny antelope that have great big black eyes and little black horns. They mate for life, and when one of the pair dies the others eats poison berries to die also. Amazing!
We wandered up for about a half hour up the 2nd largest mountain in Tanzania, Mt. Meru. It was steep and rugged and offered a gorgeous view. From up on the mountain we could see what we had all been waiting for: Twiga! Twiga is kiswahili for giraffe. There was a herd of giraffe down in the valley. After a short detour to a beautiful mountain waterfall, we wandered down to the valley floor to watch the giraffe. They are the most awkward ridiculous animals ever. And they are not shy! We got within fifteen feet of one big guy who was sitting down. He just looked at us- wait til you all get to see the amazing pictures we got with Lindsay’s camera! It was fantastic. After this Till let us go with him and his driver (European students are so different- his boss arranged for a personal driver to take him around the whole day) to go on a tour around the lakes and small crater that make up the body of the park. We saw more zebra warthogs and antelope, and then a humongous flock of pink flamingoes on this gorgeous lake. We had a lovely picnic lunch- peanut butter and crackers by the lake!
Till also gave us a ride home, turns out he’s staying on Njiro Road too! What a fortuitous day. It finally felt like we were in Africa- we can’t wait for our real safari! Serengeti or Bust!
Today we went to Arusha National Park- our first mini-safari. We got up at 5 in the morning and got ready to head out around six to catch a bus- then we realized the sun doesn’t actually start rising until 6:30 and we weren’t about to wander around in the dark. So we waited anxiously for a half hour, drinking delicous African tea. We made it to the bus station around 7 and got haggled and haggled like we never have before! “Nairobi!” “Moshi” “Dar es Salaam!” “Follow me ladies, I take you to Nairobi.” My personal favorite haggle technique--- calling us by some random white girl name and hoping we’ll respond. “Jessica! Jessica this way!” So funny.
We found a bus to Moshi, and had to haggle back with the bus driver to get him to drop us off at Usa River where the turn for the park is. We hit the road, went two hundred yards, and the bus broke down. They worked on it for about fifteen minutes and got it running again, and we set off on the bumpiest ride on the most miserable road ever. We got off at Usa River and got hounded by taxi drivers, but our finely-honed negotiating skills got us a decent fare with a friendly driver. We reached the first gate at the park and hit another setback- it was going to cost us $35 each to get in the park, and they were going to charge us to get the taxi in to drop us off at the second, real park gate. It can be really frustrating here to pay for all the incidental fees for tourists. Tanzanians pay about $2 to visit the park. This is a good thing, because all the locals should be able to afford to see the incredible things that are here in this country- but the kicker is that they charge tourists in US dollars. US dollars are difficult to come by here- you have to withdraw from the ATM in shillings and then pay a high changing fee. Why US dollars? The currency of the country is shillings. It’s a real pain. Luckily, the park is one of the few places that accepts credit card so we were okay. Still- an extra $12 just to let the taxi driver drop us off at the main gate—grrr.
About two km outside the main gate, we came around the corner to find a herd of about sixty zebra. ZEBRA! This had us all freaking out and all the troubles of the morning were forgotten. The taxi driver stopped so we could freak out properly, and we kept driving. A few turns later we came across a family of baboons sitting in the road- a about six adults and a few little ones and two very tiny ones. They looked at us and kind of moved slowly out of the way- they’ve seen cars before.
When we got to the main gate at the park we arranged for a four hour walking safari- we found another student tourist to join our group. His name is Till, from Germany here for an internship. Anyway the four of us were accompanied by a guide, a tiny woman named Hawa who carried a gun that was nearly as tall as she was. She wore green khaki fatigues, a safari hat, and an easy smile. She brought us out on a long path through a green grassland where we saw a group of buffalo and warthogs grazing together. The warthogs live with the buffalo because the buffalo are big and scary, and the buffalo appreciate the warthogs’ keen eyesight- at the sight of a predator the warthogs take of running with their tails up like antennae, signaling the alarm.
We saw a pair of dik-diks in the bush. Dik-diks are really tiny antelope that have great big black eyes and little black horns. They mate for life, and when one of the pair dies the others eats poison berries to die also. Amazing!
We wandered up for about a half hour up the 2nd largest mountain in Tanzania, Mt. Meru. It was steep and rugged and offered a gorgeous view. From up on the mountain we could see what we had all been waiting for: Twiga! Twiga is kiswahili for giraffe. There was a herd of giraffe down in the valley. After a short detour to a beautiful mountain waterfall, we wandered down to the valley floor to watch the giraffe. They are the most awkward ridiculous animals ever. And they are not shy! We got within fifteen feet of one big guy who was sitting down. He just looked at us- wait til you all get to see the amazing pictures we got with Lindsay’s camera! It was fantastic. After this Till let us go with him and his driver (European students are so different- his boss arranged for a personal driver to take him around the whole day) to go on a tour around the lakes and small crater that make up the body of the park. We saw more zebra warthogs and antelope, and then a humongous flock of pink flamingoes on this gorgeous lake. We had a lovely picnic lunch- peanut butter and crackers by the lake!
Till also gave us a ride home, turns out he’s staying on Njiro Road too! What a fortuitous day. It finally felt like we were in Africa- we can’t wait for our real safari! Serengeti or Bust!
Photos!
Here is a link to some of the photos we've been able to upload here- it's kind of an ordeal so there aren't many but it should give you an idea of what it's like out here!
Cheers,
Harry, Lint and Mischak
Cheers,
Harry, Lint and Mischak
http://www.facebook.com/album.p
http://www.facebook.com/album.p
Sunday, July 19, 2009
A day in the life of tatu mzungu daktari mwanafunzi
Some people have been asking what our daily lives are like in the hospital, so here's what our normal days are like:
7:00 -- up and making breakfast
8:00 -- catch the dalla-dalla to get to Mt. Meru Hospital
9:00 -- start rounds on patients in respective departments
1 or 2 -- leave the hospital and head to either the internet cafe or get a small lunch down by the clocktower
3:00 -- walk home, or at least to the vegetable stand or grocery store
4:30 -- arrive home and either take a nap or journal/read
6:30 -- start making dinner (yes, we make it ever night and it normally consists of either rice, potatoes, or pasta with lots of fresh vegetables. another favorite is homemade guacamole with cucumbers or wheat crisps -- they have the most amazing avocados here!)
8:30 -- finish dinner and read/journal/study medicine or swahili
11:00 -- definitely in bed
We also have been going to local churches on Sundays. Last week we went to a Swahili language Anglican church, where we understood little but felt so welcomed! Today we went with our neighbors to the English language Roman Catholic church near our home. The two kids Ceci, 9, and Tom, 3, love playing with the mzungu (white people) and loved taking us to church. We had to stand up and introduce ourselves, and when we said we were from the US, the preacher said "Ahh, give our regards to Obama ... yes we can!" They love Obama here!
7:00 -- up and making breakfast
8:00 -- catch the dalla-dalla to get to Mt. Meru Hospital
9:00 -- start rounds on patients in respective departments
1 or 2 -- leave the hospital and head to either the internet cafe or get a small lunch down by the clocktower
3:00 -- walk home, or at least to the vegetable stand or grocery store
4:30 -- arrive home and either take a nap or journal/read
6:30 -- start making dinner (yes, we make it ever night and it normally consists of either rice, potatoes, or pasta with lots of fresh vegetables. another favorite is homemade guacamole with cucumbers or wheat crisps -- they have the most amazing avocados here!)
8:30 -- finish dinner and read/journal/study medicine or swahili
11:00 -- definitely in bed
We also have been going to local churches on Sundays. Last week we went to a Swahili language Anglican church, where we understood little but felt so welcomed! Today we went with our neighbors to the English language Roman Catholic church near our home. The two kids Ceci, 9, and Tom, 3, love playing with the mzungu (white people) and loved taking us to church. We had to stand up and introduce ourselves, and when we said we were from the US, the preacher said "Ahh, give our regards to Obama ... yes we can!" They love Obama here!
Wednesday, July 15, 2009
A big day in pediatrics.
Hi, this is Hailey.
So today is Wednesday. I expected to spend the morning at what is called the CTC clinic, where outpatients with HIV come to get checked up and refill their medications. But for some reason there were about 50 people crammed into the small CTC room, and all the goings-on were in kiswahili so I decided it wasn't worthwhile to stay. I wandered back toward the larger pediatric ward in hopes of finding something to do, when I found Brad, a medical assistant from Salem, OR who happens to be here with a Salem pediatrician for the week (amazing coincidence, eh?) who was walking over to meet Dr. Temple (said pediatrician) for rounds. The first few patients were quite typical for Mt. Meru, a child with fever is treated for malaria. A child with diarrhea and vomiting are treated for gastroenteritis. A child with a cough and trouble breathing is treated for pneumonia. The cost-effectiveness of testing for these maladies is poor, it is better in general just to treat. The next patient had a congenital hydroencephalus, and I got to see my first trans-fontanelle brain ultrasound. The child was sent to a nearby city to have a shunt placed to drain the fluid off the brain, as they can't currently do it at Mt. Meru. The next patient had cerebral palsy and suspected pneumonia, in general he was in good health which was good to see as it can be quite difficult to manage with limited resources. The next thing I know, there is a lot of ruckus coming from the ward next door. We ran over to find that two infants we had been following the last several days, both with HIV and pneumocystis pneumonia, were both coding at the same time. We started rescuscitation, and one, the sicker of the two, revived and started breathing on his own after only a minute or so of ventilation. The other, we started CPR. I have never done chest compressions on an infant before, the feeling was overwhelming. We tried for several minutes with CPR and epinephrine but were unable to revive her. It was very sad. We had watched her since Monday breathe with increasing difficulty, and the doctors had been saying that she would tire out eventually. I thought that she would hang on longer than the little boy, but no. Her mom, also HIV positive, was distraught.
We came to Tanzania to experience a breadth of human suffering unlike what we would see in the States, and certainly we have had such experiences in only two short weeks. Though it is often difficult, it is always worthwhile. We are learning so much and feeling so much every day. It is nice, after months of book labor and studying, to be so vividly reminded of why we chose to come to medical school.
So today is Wednesday. I expected to spend the morning at what is called the CTC clinic, where outpatients with HIV come to get checked up and refill their medications. But for some reason there were about 50 people crammed into the small CTC room, and all the goings-on were in kiswahili so I decided it wasn't worthwhile to stay. I wandered back toward the larger pediatric ward in hopes of finding something to do, when I found Brad, a medical assistant from Salem, OR who happens to be here with a Salem pediatrician for the week (amazing coincidence, eh?) who was walking over to meet Dr. Temple (said pediatrician) for rounds. The first few patients were quite typical for Mt. Meru, a child with fever is treated for malaria. A child with diarrhea and vomiting are treated for gastroenteritis. A child with a cough and trouble breathing is treated for pneumonia. The cost-effectiveness of testing for these maladies is poor, it is better in general just to treat. The next patient had a congenital hydroencephalus, and I got to see my first trans-fontanelle brain ultrasound. The child was sent to a nearby city to have a shunt placed to drain the fluid off the brain, as they can't currently do it at Mt. Meru. The next patient had cerebral palsy and suspected pneumonia, in general he was in good health which was good to see as it can be quite difficult to manage with limited resources. The next thing I know, there is a lot of ruckus coming from the ward next door. We ran over to find that two infants we had been following the last several days, both with HIV and pneumocystis pneumonia, were both coding at the same time. We started rescuscitation, and one, the sicker of the two, revived and started breathing on his own after only a minute or so of ventilation. The other, we started CPR. I have never done chest compressions on an infant before, the feeling was overwhelming. We tried for several minutes with CPR and epinephrine but were unable to revive her. It was very sad. We had watched her since Monday breathe with increasing difficulty, and the doctors had been saying that she would tire out eventually. I thought that she would hang on longer than the little boy, but no. Her mom, also HIV positive, was distraught.
We came to Tanzania to experience a breadth of human suffering unlike what we would see in the States, and certainly we have had such experiences in only two short weeks. Though it is often difficult, it is always worthwhile. We are learning so much and feeling so much every day. It is nice, after months of book labor and studying, to be so vividly reminded of why we chose to come to medical school.
Saturday, July 11, 2009
A little bit of my Oregon just died
Many sights and many sounds, but if I had to pick my favorite (/confusing/terrifying) of it all so far, it might go something like this...
Dalla dalla rides with standing room only and live chickens.
The fact that 2/3 of us have been told that we look like Michael Jackson.
Dumping all of our garbage in the backyard pit that the local cat (pillipilli manga) sleeps on (see blog title).
"Cold weather" (60-ish F) and the idea that pregnant women deliver from home rather than face the chill en route to hospital.
The requisite "i" that Tanzanians add to the end of all English words (Breachi baby, baby sexi, goodi price).
At the market: "Hey, looking is free!"
The he/she confusion among some doctors ("His uterus" "Her testes")
GIANT shiny gold Obama belt buckles.
Obama everything.
In-house cockroach tally.
The swarms of children that run in and out of our house.
The idea that street children carry feces around and threaten to throw them at people if they aren't given money (I guess it's better than a knife?)
I'm sure there are plenty more. And there are so many from the hospital, even after only a week, that I can't really begin to describe or that don't seem appropriate for a lengthy list. Like watching a nun suffer through a hernia surgery in which the medication wasn't sufficient to prevent her feeling the first cuts. Or the many many children in the burn unit. And the tens of femur fracture patients that spend weeks upon weeks in the hospital with bags of rocks pulling traction on their broken bone to allow it to heal (semi-)properly. It's awe-inspiring and tragic, and amazing what people can do with limited resources all at the same time.
L
Dalla dalla rides with standing room only and live chickens.
The fact that 2/3 of us have been told that we look like Michael Jackson.
Dumping all of our garbage in the backyard pit that the local cat (pillipilli manga) sleeps on (see blog title).
"Cold weather" (60-ish F) and the idea that pregnant women deliver from home rather than face the chill en route to hospital.
The requisite "i" that Tanzanians add to the end of all English words (Breachi baby, baby sexi, goodi price).
At the market: "Hey, looking is free!"
The he/she confusion among some doctors ("His uterus" "Her testes")
GIANT shiny gold Obama belt buckles.
Obama everything.
In-house cockroach tally.
The swarms of children that run in and out of our house.
The idea that street children carry feces around and threaten to throw them at people if they aren't given money (I guess it's better than a knife?)
I'm sure there are plenty more. And there are so many from the hospital, even after only a week, that I can't really begin to describe or that don't seem appropriate for a lengthy list. Like watching a nun suffer through a hernia surgery in which the medication wasn't sufficient to prevent her feeling the first cuts. Or the many many children in the burn unit. And the tens of femur fracture patients that spend weeks upon weeks in the hospital with bags of rocks pulling traction on their broken bone to allow it to heal (semi-)properly. It's awe-inspiring and tragic, and amazing what people can do with limited resources all at the same time.
L
Thursday, July 9, 2009
Michael Jackson, what?
The religious picture in this country is really special- equal parts Muslim, Christian, and traditional belief, patients from all these backgrounds walk in to the hospital for us to see, sometimes to very peculiar effect.
One pediatric physician, a Christian man with a Masai background, said that he was very impressed with the remarks made by the preacher at "the American singer's" funeral. I assumed he meant Jesse Jackson, who I think spoke at Michael Jackson's funeral? The doctor then asked me why Michael was buried without his brain. I explained that I didn't know anything about this. The doctor said that his friends were talking about it and that they didn't understand why Americans are buried without their brains. I told him that as far as I knew, most people meet their maker brains intact, but perhaps Jackson is an exception? Is his brain going to a museum or something?? Someone please comment. :)
One pediatric physician, a Christian man with a Masai background, said that he was very impressed with the remarks made by the preacher at "the American singer's" funeral. I assumed he meant Jesse Jackson, who I think spoke at Michael Jackson's funeral? The doctor then asked me why Michael was buried without his brain. I explained that I didn't know anything about this. The doctor said that his friends were talking about it and that they didn't understand why Americans are buried without their brains. I told him that as far as I knew, most people meet their maker brains intact, but perhaps Jackson is an exception? Is his brain going to a museum or something?? Someone please comment. :)
Oh wow ... there's a foot
I (Michelle) was back on the labor ward today. It was very slow when I arrived and I assumed that I might be transferring to another unit for rounds or scrubbing in for surgery. Thus I did not immediately gown up in delivery attire. That was a mistake.
I was just talking to the physician on duty (Dr. Mkamba) and a women walked in and spoke to one of the nurses in swahili. I heard the words "second stage" in there somewhere and then the nurse told me to go deliver her (some of them haven't quite figured out despite my explanations that I am not qualified to do unassisted deliveries yet). I asked the physician for assistance and we headed over the assess the situation. When we got there the head was almost out. The physician just walked me through things, but I did each and every step myself for the very first time! It all happened so quickly and a healthy 3.2 kg baby boy was born!
I was excited about my first unassisted delivery and I just about to go get officially gowned up when I was directed to assist another woman. I again brought Dr. Mkamba with me, but he did not bring gloves or gown up either. We assessed the woman, ruptured her membranes, and I prepared for another delivery. And then, we saw a foot. Oh no ... this baby is breech and it is WAY too late to do a C-section. Okay, Dr. Mkamba gowned up and got more assistance and we prepared for a breech delivery. The baby came within a minute and a healthy 2.6 kg baby girl was born!
Breech deliveries are a three person effort and are very different from normal cephalic deliveries. I am so happy to have learned the skill of a breech delivery. In America, every woman who presents in a breech position goes to C-section, so physicians never learn the skill of a vaginal breech delivery. But what happens if a situation like this presents where it is WAY too late for a C-section?
Hailey worked in the HIV childrens clinic today where she saw a few mothers who didn't even bring their kids with them to the appointments. They just brought their child's medical record and left him/her at home to work in the house. The physician that Hailey was working with was frustrated and just kept saying "I treat kids, not cards!"
Lindsay was in the theatre today and saw a few hernia repairs. There were many observers in these rooms, and because they are more crowded than C-section deliveries it can be difficult to see and/or learn much from these experiences.
Another great day at Mt. Meru!
I was just talking to the physician on duty (Dr. Mkamba) and a women walked in and spoke to one of the nurses in swahili. I heard the words "second stage" in there somewhere and then the nurse told me to go deliver her (some of them haven't quite figured out despite my explanations that I am not qualified to do unassisted deliveries yet). I asked the physician for assistance and we headed over the assess the situation. When we got there the head was almost out. The physician just walked me through things, but I did each and every step myself for the very first time! It all happened so quickly and a healthy 3.2 kg baby boy was born!
I was excited about my first unassisted delivery and I just about to go get officially gowned up when I was directed to assist another woman. I again brought Dr. Mkamba with me, but he did not bring gloves or gown up either. We assessed the woman, ruptured her membranes, and I prepared for another delivery. And then, we saw a foot. Oh no ... this baby is breech and it is WAY too late to do a C-section. Okay, Dr. Mkamba gowned up and got more assistance and we prepared for a breech delivery. The baby came within a minute and a healthy 2.6 kg baby girl was born!
Breech deliveries are a three person effort and are very different from normal cephalic deliveries. I am so happy to have learned the skill of a breech delivery. In America, every woman who presents in a breech position goes to C-section, so physicians never learn the skill of a vaginal breech delivery. But what happens if a situation like this presents where it is WAY too late for a C-section?
Hailey worked in the HIV childrens clinic today where she saw a few mothers who didn't even bring their kids with them to the appointments. They just brought their child's medical record and left him/her at home to work in the house. The physician that Hailey was working with was frustrated and just kept saying "I treat kids, not cards!"
Lindsay was in the theatre today and saw a few hernia repairs. There were many observers in these rooms, and because they are more crowded than C-section deliveries it can be difficult to see and/or learn much from these experiences.
Another great day at Mt. Meru!
Wednesday, July 8, 2009
The adventures of Harry, Lint, and Meeshak
Yesterday (July 7th) was Saba Saba holiday in Tanzania, so most of the restaurants, stores, and even the Peds & Surgery departments at Mt. Meru were closed. Dr. Lyimo (our advisor here) told us to take the day off, but we decided we would come in anyway. We all were in the Labor & Delivery ward. Now that we are starting to get more used to the process of birth at Mt. Meru, we are getting more involved. Dr. Ali and Dr. Lyimo were both there so they could teach us examination and delivery skills in English :)
It was exciting ... Hailey delivered her first baby and Lindsay scrubbed in on her first C-section. Overall the count is Hailey assisting on two deliveries (two girls), Michelle assisting on two deliveries (two boys), and Lindsay assisting on a C-section delivery of a girl and she observed a C-section of a twin boy & girl.
After each baby is born, it is weighed and taken to a large bassinette where babies basically "spoon" each other under a heat lamp. It's very cute. And they are all wrapped up in colorful ktenges that their mothers have brought for them. This is how the mother identifies her baby ... by the color of the ktenge, not by an identification band.
Today Lindsay was back doing surgery rounds where she saw a case of anthrax and many broken femurs. We're currently trying to understand why there are so many femur fractures here ... that's the biggest bone in the body!
Hailey was back in the pediatric department, where she saw lots of cases of malaria, as well as a few cases of malnutrition (Kwashiorkor and Merasmus). She also saw a 2 year old boy with late stage AIDs. Hailey says that the fevers of the kids there are just "boiling."
Michelle was back on the labor ward where I assisted in a delivey of yet another boy and scrubbed in on a C-section delivery of another little boy (see a pattern?). The doctors told me that I was very timid during the surgery ... but I reminded them that this was the first time I had scrubbed in and that I would be better next time.
We are all smiling now when we finish our days! We're hoping to go to the coast this weekend.
It was exciting ... Hailey delivered her first baby and Lindsay scrubbed in on her first C-section. Overall the count is Hailey assisting on two deliveries (two girls), Michelle assisting on two deliveries (two boys), and Lindsay assisting on a C-section delivery of a girl and she observed a C-section of a twin boy & girl.
After each baby is born, it is weighed and taken to a large bassinette where babies basically "spoon" each other under a heat lamp. It's very cute. And they are all wrapped up in colorful ktenges that their mothers have brought for them. This is how the mother identifies her baby ... by the color of the ktenge, not by an identification band.
Today Lindsay was back doing surgery rounds where she saw a case of anthrax and many broken femurs. We're currently trying to understand why there are so many femur fractures here ... that's the biggest bone in the body!
Hailey was back in the pediatric department, where she saw lots of cases of malaria, as well as a few cases of malnutrition (Kwashiorkor and Merasmus). She also saw a 2 year old boy with late stage AIDs. Hailey says that the fevers of the kids there are just "boiling."
Michelle was back on the labor ward where I assisted in a delivey of yet another boy and scrubbed in on a C-section delivery of another little boy (see a pattern?). The doctors told me that I was very timid during the surgery ... but I reminded them that this was the first time I had scrubbed in and that I would be better next time.
We are all smiling now when we finish our days! We're hoping to go to the coast this weekend.
Monday, July 6, 2009
Mt. Meru Hospital, Day 1
Hello friends and loved ones!
Today the Tanzania trio went to the hospital for a short orientation. We met the regional medical officer, who seemed totally suprised to see us and asked why we hadn't given word that we were coming (!), then the general medical officer who was wonderfully friendly and seemed excited for us to start.
After that, we split up: Michelle to OB/GYN, Hailey to pediatrics, Lindsay to surgery. In OB/GYN Michelle was witness to eight successful births. Hailey toured the peds malnutrition, GI, and HIV/TB wards. Lindsay triaged and casted a fracture. And all this before 2:30!
We go home tonight highly motivated to learn as much medicine and kiswahili as we can as fast as we can. Hopefully we will become useful to the staff and patients as time goes on.
Today the Tanzania trio went to the hospital for a short orientation. We met the regional medical officer, who seemed totally suprised to see us and asked why we hadn't given word that we were coming (!), then the general medical officer who was wonderfully friendly and seemed excited for us to start.
After that, we split up: Michelle to OB/GYN, Hailey to pediatrics, Lindsay to surgery. In OB/GYN Michelle was witness to eight successful births. Hailey toured the peds malnutrition, GI, and HIV/TB wards. Lindsay triaged and casted a fracture. And all this before 2:30!
We go home tonight highly motivated to learn as much medicine and kiswahili as we can as fast as we can. Hopefully we will become useful to the staff and patients as time goes on.
Saturday, July 4, 2009
Roaches, flruit flies, killer mosquitoes. Bring it on.
So--- (this is Hailey)
I woke up, for probably the first time in my life, at 4:30 in the morning. WIDE awake. So I sat around in the dark, got really freaked out when I heard a man outside the window before realizing it was the night watchmen watering the plants, I read some, knitted some, etc. Then I heard a creepy rustling from the living room and got my headlamp out to investigate-- there was a cockroach, a little less than two inches long, perched on Michelle's handbag on the carpet. When my light shined on it it kind of skittered away. Grossed out, I just went back to my room. My phone beeped out about three hours later when the sun was mostly up and when I went to the living room to check it, I stepped right on another roach outside my door. Then I saw another on the rug. I yelped a lot then, and woke up Lindsay and Michelle and went on a Raid rampage. Apparently fumigating our whole house is something we need to do everyday. Good grief! We're going to get brain damaged from the Raid but there will be no more roaches!
We smashed about a dozen more baby roaches in the kitchen and a few of the remaining fruit flies from the rash of them we had yesterday out of the bananas. So far today, though, I have seen no mosquitos. This is good! Technically they're the only bugs we're really supposed to worry about, and with all the permethrin, Raid, DEET, nets, and long sleeves and pants we've got we'll come back shizont-free.
The rest of today I think we'll wander around Arusha and try to get oriented to the city some- it's pretty crazy and the cramped dalla-dallas (public transit vans) don't really help. You can't see out of them and every time they turn or move it feels like your life is at stake.
Cheers everyone! Kwa heri!
I woke up, for probably the first time in my life, at 4:30 in the morning. WIDE awake. So I sat around in the dark, got really freaked out when I heard a man outside the window before realizing it was the night watchmen watering the plants, I read some, knitted some, etc. Then I heard a creepy rustling from the living room and got my headlamp out to investigate-- there was a cockroach, a little less than two inches long, perched on Michelle's handbag on the carpet. When my light shined on it it kind of skittered away. Grossed out, I just went back to my room. My phone beeped out about three hours later when the sun was mostly up and when I went to the living room to check it, I stepped right on another roach outside my door. Then I saw another on the rug. I yelped a lot then, and woke up Lindsay and Michelle and went on a Raid rampage. Apparently fumigating our whole house is something we need to do everyday. Good grief! We're going to get brain damaged from the Raid but there will be no more roaches!
We smashed about a dozen more baby roaches in the kitchen and a few of the remaining fruit flies from the rash of them we had yesterday out of the bananas. So far today, though, I have seen no mosquitos. This is good! Technically they're the only bugs we're really supposed to worry about, and with all the permethrin, Raid, DEET, nets, and long sleeves and pants we've got we'll come back shizont-free.
The rest of today I think we'll wander around Arusha and try to get oriented to the city some- it's pretty crazy and the cramped dalla-dallas (public transit vans) don't really help. You can't see out of them and every time they turn or move it feels like your life is at stake.
Cheers everyone! Kwa heri!
Africa is a continent, not a country.
We awoke this morning to gorgeous music blasting from the neighbors' front porch. They are terribly patient with our terrible Kiswahili and extremely friendly. Hamisa, a girl across the way, took us into town to see the hospital and spent the better part of her day taking us from one place to another. The town is bigger than we expected and a little overwhelming. Problem #1: No street lights. I hate to add concern to anyone's mind, but we've wandered into traffic several times now and will hopefully gain some skills in dodging cars and Dalla Dalla bus-vans.
The hospital is also larger than expected; it sprawls across several grassy areas where patients' families dry clothes. Vendors sell fruit and coke outside the gates. Patients fill most of the halls, but it appears to run pretty smoothly (though it was hard to tell from our morning and afternoon trips of 30mins each). We will get a better tour next week when we start an orientation of sorts, but it was clear that the supplies are very much needed. Dr. Lyimo emphasized that they were nearly out of sutures and the exam rooms were pretty sparse, as expected.
Around town, we bought food and took in the overwhelming surroundings. As we read, Muslim and Christian faiths seem to meld seamlessly around town. Vendors are everywhere. The streets are falling out in most places; dirt paths and ditches break up the "sidewalk." Cars and vans are everywhere, as are pedestrians.
It is a little overwhelming to take in all at once, but once we get our bearings, I think we can give a more thorough description (and hopefully make it to and from work without getting lost).
L, M, H
The hospital is also larger than expected; it sprawls across several grassy areas where patients' families dry clothes. Vendors sell fruit and coke outside the gates. Patients fill most of the halls, but it appears to run pretty smoothly (though it was hard to tell from our morning and afternoon trips of 30mins each). We will get a better tour next week when we start an orientation of sorts, but it was clear that the supplies are very much needed. Dr. Lyimo emphasized that they were nearly out of sutures and the exam rooms were pretty sparse, as expected.
Around town, we bought food and took in the overwhelming surroundings. As we read, Muslim and Christian faiths seem to meld seamlessly around town. Vendors are everywhere. The streets are falling out in most places; dirt paths and ditches break up the "sidewalk." Cars and vans are everywhere, as are pedestrians.
It is a little overwhelming to take in all at once, but once we get our bearings, I think we can give a more thorough description (and hopefully make it to and from work without getting lost).
L, M, H
Adventures in Amsterdam (almost...)
We left for the Newark airport 5 1/2 hours before our flight so we could have some relaxation time and some good food before our flight to Amsterdam. Little did we know we would really need those 5 1/2 hours. It took 3 1/2 from the time we left our hotel that was close to the airport until we got through security. We stood in the checkin line for almost 2 hours! WARNING: DO NOT, I repeat DO NOT fly continental international. They stink.
After much waiting in line, we got through security and headed to the Heineken bar to use our lunch vouchers from the airlines and get a nice cold beer before our flight. (Note: this bar/restaurant may be the only good thing about the Newark airport). We got to our gate and then they checked out passports for like the 4th time. Frustrating.
The flight to Amsterdam was uneventful, and even though it was night none of us slept for more than an hour. Those personal video screens are just too dang tempting!
We arrived in Amsterdam and set to get the boarding passes that Continental refused to give us for our last flight. Little did we know how incompetent the Continental people in Newark truly were. Hailey and Michelle were never booked on the flight to Kilimanjaro. So the very nice KLM guy told us he would try to get us on today, but that the flight was already full (there were 3 large volunteer groups from Europe and US on that flight). Long story short ... Michelle finally lost it and started crying, and then she found the most adorable baby from Tanzania to play with and then things were good again. Hailey and Michelle were the last two people on the flight!
The one good screwup that Continental made was to put Lindsay in first class. Nice! She got pampered and drank wine out of real glasses the whole way while Michelle sat in the last row and Hailey got a middle seat. I was so impressed with the KLM flight ... the food was excellent, they treated us so well, they refilled our drinks and brought us water at least once an hour, and they didn't even complain when Michelle walked on after everyone was seated with her giant backpack. A very nice flight attendant moved his personal stuff to allow for my backpack.
We arrived at Kilimanjaro airport right on time, and got ready for customs. We were all concerned about this, but it was actually the least stressful part of the trip! We just paid our $100 for the visa and they barely even looked at our bags. A suture even popped out of Michelle's bag, and the guy didn't even care at all. The only bad thing is Hailey's luggage wasn't there! Ugh. It never made it on the plane in Amsterdam.
But good news .... Hailey got her luggage this morning without any damage or anything missing! This is the most stressful time I have ever had flying, but I'm so glad we finally made it. A fabulous cab driver picked us up and took us right to our door.
That's it folks ... we're in Africa!
After much waiting in line, we got through security and headed to the Heineken bar to use our lunch vouchers from the airlines and get a nice cold beer before our flight. (Note: this bar/restaurant may be the only good thing about the Newark airport). We got to our gate and then they checked out passports for like the 4th time. Frustrating.
The flight to Amsterdam was uneventful, and even though it was night none of us slept for more than an hour. Those personal video screens are just too dang tempting!
We arrived in Amsterdam and set to get the boarding passes that Continental refused to give us for our last flight. Little did we know how incompetent the Continental people in Newark truly were. Hailey and Michelle were never booked on the flight to Kilimanjaro. So the very nice KLM guy told us he would try to get us on today, but that the flight was already full (there were 3 large volunteer groups from Europe and US on that flight). Long story short ... Michelle finally lost it and started crying, and then she found the most adorable baby from Tanzania to play with and then things were good again. Hailey and Michelle were the last two people on the flight!
The one good screwup that Continental made was to put Lindsay in first class. Nice! She got pampered and drank wine out of real glasses the whole way while Michelle sat in the last row and Hailey got a middle seat. I was so impressed with the KLM flight ... the food was excellent, they treated us so well, they refilled our drinks and brought us water at least once an hour, and they didn't even complain when Michelle walked on after everyone was seated with her giant backpack. A very nice flight attendant moved his personal stuff to allow for my backpack.
We arrived at Kilimanjaro airport right on time, and got ready for customs. We were all concerned about this, but it was actually the least stressful part of the trip! We just paid our $100 for the visa and they barely even looked at our bags. A suture even popped out of Michelle's bag, and the guy didn't even care at all. The only bad thing is Hailey's luggage wasn't there! Ugh. It never made it on the plane in Amsterdam.
But good news .... Hailey got her luggage this morning without any damage or anything missing! This is the most stressful time I have ever had flying, but I'm so glad we finally made it. A fabulous cab driver picked us up and took us right to our door.
That's it folks ... we're in Africa!
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