Back waking up in Machame again! Often, the mornings here are quite cloudy because we're at such altitude and the top of Kilimanjaro is shrouded in white. But it was perfectly clear today and the twin peaks rose beautifully above the hospital as I walked to chapel. I don't think it's possible to get tired of that view.
Luckily for us, most of the medical discussions in Tanzania are done in English (except for actually talking to patients unfortunately!). Although this usually makes things a lot easier, sometimes the strong African accent can cause problems. Like with the case presentation today. At first, I thought the patient had a simple hernia. But when she started talking about how the hernia had attacked and bitten the guy, it slowly dawned on me that maybe all was not as it seemed.
To my horror, I suddenly realised that she was actually talking about a hyena! This turned out to be quite a horrific case. The patient was a ten year old boy who got mauled by a rabid hyena while trying to protect his family's goat. So as well as having his head and hand bitten to shreds, he now most likely has rabies.
I went to visit the boy in ICU after the meeting. He was all bandaged up and thankfully doing okay. Unfortunately there is no pain relief given here, but the people are admirably stoic. Even when being examined and having his dressings changed, this boy barely let out a sound!
I'm still not entirely sure what the difference between the ICU and a normal ward is here – they look the same except for an oxygen cylinder in ICU that looks like it has never been used! The ICU has no monitoring equipment at all; the patients are not intubated or sedated and there's no pain relief. I think a lot of the post-major op patients come here for a bit, so they can have closer observation by the nursing staff. And by closer observation, I mean one nurse to four patients as opposed to one nurse to twenty patients in the other wards.
Although often tragic, we are certainly getting to see a lot of things here in Africa that just wouldn't occur in Australia. I had never seen a case of rabies before and it is interesting to learn more about it and how to treat it. This is why we're here after all!
I later found out that the boy's father had managed to kill the hyena while rescuing his son, which everyone was rather pleased about because an autopsy can now be performed to determine conclusively if the animal was definitely rabid or not.
After the visit to the ICU, I went on a ward round through some of the general beds. The first two patients I saw were motor bike accidents, which is hardly surprising considering how the locals drive here. Also, I am yet to see anyone wear a helmet. The orthopaedics department is thriving!
Interestingly, many of the patients we see have similar conditions to what we get back at home, except they are sometimes treated differently. This can either be due to a lack of resources (for example, treating everything infectious with amoxycilin because there are no antibiotics available) or just plain wrong (treating suicidal depression with omeprazole to prevent 'stress ulcers' of the stomach).
But just when you think that things are so limited, I often get surprised by what can actually be done here too. I spent some time in surgical outpatients today and saw a man with dysphasia. He is to be investigated with a barium swallow and endoscopy, which was pleasantly surprising to discover that both could be done at the hospital.
Conditions here for the patients are tough though. The beds are essentially rudimentary steel frames with only a thin layer of foam instead of a mattress. There are no pillows for any of the patients either, so sucks to be you if you have heart failure. Plus, there is no ambulance, so people have to make their own way to the hospital even if they've been involved in a nasty road accident.
I then spent the afternoon exploring the village of Machame. It's really spread out, with a few clusters of houses and shops here and there with long stretches of rainforest or farmland in between. There are some really big, nice houses with manicured gardens, but lots more small huts that are considerably more humble.
There are heaps of animals in Machame, although disappointingly they're all farm animals like what I could see back in Australia. Lots of cows, hens, roosters and donkeys (no sheep though!). There are even dogs and cats, but no cool African animals in this part of the country. Apparently there are some monkeys who live in the forest around our house, but I'm yet to see one unfortunately. You have to go to one of the national parks to get proper African animals. Justin's probably seen heaps by now!
Baadaye,
Michael
Things that went wrong: Day 8 edition
- My initial plan for the day at the hospital was to spend today in the paediatric ward. But when I got there I was told that the doctor who normally sees the patients was a bit tired after a late night and decided not to come in today. As outrageous as I thought that was, it does kind of fit with the typical Tanzanian outlook on life that nothing is too urgent that can't just be done tomorrow. Hope none of the kids were too sick!
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