So, it has been a while. I got behind on posts because I think I managed to catch African RSV as soon as I got off the plane. By Monday I had a a head cold with cough and sore throat that was pretty miserable. However, I think my immune system had seen one of it’s cousins, because I recovered quicker than I usually do from such things. It still made Mon and Tues a bit of a drag to learn a new and completely different hospital and team.
For the record, I didn’t really expect to be working in a team. Not sure what I expected, though.
I also got behind on posting because it is hard to update a blog when the power is out. Tues and Weds nights the power was off from when we got home until ~9 PM local time for line repairs. Basically, they took down the wires, chopped back some trees, and then hung the wires back up.
Since there’s not been much updating, I will attempt to recap by the day. I’ve taken a few pics, too, which I will try to post tomorrow or Sunday (most of pics will probably be taken towards the end of my stay when people here know me better; also, the Masai aren’t keen on photography).
Got to see Selian for the first time and see the crew at work. Pretty much everyone here from the US is from, or trained in, Minnesota. Dr. Steve Swanson is a peds ID guy, with training in tropical medicine, and he was acting attending, but this was his last day. He’s smart, a good teacher, and ridiculously thorough in his exams.
There’s a married couple of med students from UofM, Kelly and Lauren, but this was their last day here too before heading off to other medical areas in the city. There are two family med people, a year out from residency, who share the house I’m in, Janna and Eric. Eric rounded on peds today but goes to medicine tomorrow, and Janna took a “me” day and just stayed home.
The service has shrank recently. Steve told me they were rounding on 30+ kids the last week or so, with no help from Tanzanian AMOs (assistant medical officers) or interns. Now it is getting more manageable, 17 today with a few discharges. Diagnoses on the ward: bronchiolitis, pulmonary TB, presumed disseminated TB, presumed malaria, gastroenteritis, severe malnutrition (marasmus, kwashiorkor, marasmic kwashiorkor), HIV, presumed malaria, and combinations thereof. Admitted one myself, new patient in the ICU. 14mo, h/o severe malnutrition, discharged end of last week, with respiratory distress and hypoxia. Looks pretty sick, visibly pale, Hgb 7.5 if you trust the lab. Clinically consistent with bronchiolitis, but history is sketchy at best. Given poor nutrition, and overall status, elect to cover for pneumonia anyway. No X-rays available today (Easter Monday is a holiday?) and we’d have to take her off oxygen to get the film anyway.
Got a ride home with Steve after lunch (beans and rice at the canteen at the hospital, for 2000 Tsh). Went to bed early after kindhearted roomies fed me – no trip to grocery today. Ron (a semi-retired rheumatologist from MN) is planning a group trip to the store tomorrow, have to make a list of supplies for someone to get me.
Today is my first real day doing clinical stuff – yesterday was just a day of getting my feet wet. Janna is coming to the hospital today, so I won’t be flying solo. Also, the pediatric AMO, Winnie, is supposed to be back today. She was out with an injured foot last week. We’re going to try to hit the ground running as best we can. We manage to see 17 kids between 1030 when rounds finally start, and 1:30. Winnie is helpful at times, but also randomly disappears. But when she’s there, she’s invaluable, since she is experienced and she speaks the Masai language. Many of the Masai near here do not speak Swahili, especially the women. The language barrier with Swahili is rough too, but the pediatric ward nurse, Francesca, is an amazing help. After an hour I can tell that she’s above and beyond many of the other nurses here in both language and clinical skills, and we’re lucky she’ll be around to help out.
Lunch again is rice and beans. Simple but effective.
We walk home today. The road from Selian to Ilboru is basically just a really wide hiking trail, with lots of small farms and the occasional school house or shop (Swahili: duka) along the way. It is relatively hilly, with a few steep rocky spots. There are many children out along the way: some too young for school, many more who are old enough for school but are kept home due to the cost of schooling or the need for help around the homestead, and some, later in the day, in school uniforms walking home. The youngest kids tend to greet us by calling “mizungu” which means “foreigner” but is generally used for white people. Older kids say “good morning”, typically regardless of time of day, but some of the students get more advanced with “good afternoon” or “hello, how are you doing”. Many of the children who are not in school also know how to say “give me my money” or “take a picture”. So far I’ve obliged neither for fear of starting a trend. I’ll probably give in to the latter, and give away some candy, before I leave.
Ron somehow forgot to take Lauren and Kelly to the store today, and they had my grocery list. So, the roomies kindly feed me again, and we have a romantic candlelight dinner because the power is out. We look like a bunch of ENT docs because we’re all wearing headlamps, too.