Mon 2nd Jan 2012
We woke up in Machame for the last time ever and headed off to chapel. We had come prepared with a Swahili farewell speech we wrote yesterday and were able to give it at the end of the service. We got laughed at slightly less than on our first day, so hopefully our pronunciation has improved. The head doctor then gave a massive speech about us, despite barely meeting us. He seemed very pleased to have such an excellent opportunity to make another lengthy speech, so I feel like we've done our good deed for the day.
The rest of the morning was spent on long goodbyes and taking about a million photos of the hospital and our new rafikis we have made here (plus several of the hospital dog). It will be sad to leave this place! Will definitely not miss the roosters though.
Mr Mushi was also sad to see us go and was kind enough to drive us the full hour to Moshi himself. What a gentleman!
For the interest of everyone who has been kind enough to donate and help us with our fundraising efforts, we have spoken to Mr Mushi about what we all think is the best way to spend the $4000 we raised. We're going to finalise this all when we get back to Australia, so we will keep you posted. We can say firsthand that the money will make a big difference here, so thank you all very much!
Tomorrow we leave for our six-day trek to (hopefully) the top of Kili. Many people have enquired about our dedicated training regimen for this undertaking and the response has always been that we intend to use the first three days of the hike as intensive training for the last three. There's nothing quite like learning on the job!
Arriving in Moshi, we went to the hotel to meet our tour group. It was quite a culture shock getting here, as we are not used to being around foreigners! I'm already sick of looking at white people, speaking in English and paying for things in American dollars. It's so touristy or, as Emmy would say, it's just not the real Africa.
Anyway, we went for our our pre-trek briefing today, where we discovered that the Machame route up Kilimanjaro is actually a really difficult one and recommended for experienced hikers. Whoops. This really doesn't bode well.
We then spent the evening relaxing by the pool, having what would be our last showers for quite some time and enjoying the feel of a soft mattress and unmangled feet.
Goodbye,
Possibly forever,
Michael
The farewell speech to Machame Hospital:
Habari za asubuhi. Heri ya mwaka mpya. Leo tunahondoka Machame. Tumefurahi kuwa nanyi kwa pamoja. Asanteni kwa ushirikiano weru kwetu. Tumefurahi kabisa. Karibuni Australia. Mungu awabariki.
Good morning and happy new year. Today we will leave Machame. We are very pleased to be here with you all. Thank you for all that you have done for us. We have greatly enjoyed being here. We have learnt a lot. You are all welcome to come to Australia. God bless you all.
Day 21 - Heri ya mwaka mpya!
Sun 1st Jan 2012
After the excitement of counting in the new year and then going to sleep at 12:01, today was a massive non-event. We woke up late, discovered the whole town was hungover, so went back home to do basically anything that didn't involve yahtzee.
We have put a great deal of thought into our New Year's resolutions - Justin's is not to die while climbing Kilimanjaro and mine is to just not die in general on this trip. Hopefully we go a bit better with these than normal new year resolutions.
Unfortunately, the other students had a horrible New Year's in Moshi, getting robbed four times, locked out of their hotel and then losing their key to their dorm, so they couldn't get in when they got back to Machame. We had heard a lot about how dangerous the big towns can be on nights like that, so it feels like an excellent decision to stay in little old Machame. Hope you are proud of our safe and responsible decision making, Mum!
We hen spent most of today washing, packing and cleaning which was highly boring so there's not much to write about unfortunately.
The evening was spent evening drinking lots of water so that our tear ducts would be nice and full for all the goodbyes we would have to say tomorrow - our last day at the hospital!
Michael
After the excitement of counting in the new year and then going to sleep at 12:01, today was a massive non-event. We woke up late, discovered the whole town was hungover, so went back home to do basically anything that didn't involve yahtzee.
We have put a great deal of thought into our New Year's resolutions - Justin's is not to die while climbing Kilimanjaro and mine is to just not die in general on this trip. Hopefully we go a bit better with these than normal new year resolutions.
Unfortunately, the other students had a horrible New Year's in Moshi, getting robbed four times, locked out of their hotel and then losing their key to their dorm, so they couldn't get in when they got back to Machame. We had heard a lot about how dangerous the big towns can be on nights like that, so it feels like an excellent decision to stay in little old Machame. Hope you are proud of our safe and responsible decision making, Mum!
We hen spent most of today washing, packing and cleaning which was highly boring so there's not much to write about unfortunately.
The evening was spent evening drinking lots of water so that our tear ducts would be nice and full for all the goodbyes we would have to say tomorrow - our last day at the hospital!
Michael
Day 20 - Happy New Year
Sat 31st Dec 2011
Today is New Year's Eve! And we finally got an invite to an exclusive Swedish party in Moshi. As hard as it was, we stood them up. This is mostly because we had a better offer - a New Year's party with a doctor from the hospital, his friends and family. I later realised that it was actually a baptism. Altough I probably should've guessed this since he told us to meet him at a church at 10am...
We actually didn't know the name of the docor who invited us to his place to celebrate the christening of his granddaughter. All we know is that he travelled to Australia a few years ago and was very impressed with the generosity and hospitality of Australians. So he wanted to return the favour!
This morning was going pretty well as our rooster alarm clock woke us up. I swear he must be blind though, because he crows all bloody day! We woke up early to get ready. But Ally soon called Michael. We were now running late. Talking to Michael while he was on the phone was like talking to a patient having a 30 minute absence seizure. Nothing goes in.
Again I had no breakfast as the Swedish girls had taken my bananas. They had also taken the rest of my water and toilet paper. I thought we would get robbed by some locals in Arusha, not two retarded Swedish girls.
So after skipping breakfast we walked down the hill to the markets. On our way we saw someone wearing a helmet when riding his motor bike. First helmet sighting in 3 weeks. We missed the entire church service apart from the last 5 mins...thanks Ally. The doctor then took us to his house right in the middle of the village. He showed us around his extensive garden - he has heaps of banana trees, coffee trees and paw paws. And after Michael spilt 2 drinks and called his grand-daughter a boy...we were off to a good start.
The party was supposed to start at 11am, but because this is Tanzania...it started at 4pm. Over 150 guests came over for the party, most of them were hours late.
The food was amazing. We had goat, banana stew, heaps of rice and meat (for a change)...and this deceiving sauce which turned out to be the most spicy thing I've ever had. It destroyed my tongue and bowels.
We met heaps of locals our age. One girl was quite a character. She invited us to a New Year's party in Moshi..but after realising Michael has a girlfriend and I was catholic, she ditched us. Snob.
The day was pretty relaxed though. We just sat in a rainforest drinking Amurula listening to African music. It was also great to hear from all my friends and Michael's family that New Years was as enjoyable back home as it was here.
By the end of the night we still had no clue what the doctors name was. But after overhearing someone call him 'Dr Masawe'...we just assumed this was his name...we hope. Before he took us home, he took a leak in his garden...like all good consultants would.
We then went back to our dorm, crahed a local student party, left when we found out they were a cult and went home to count down to midnight. A great way to welcome the New Year.
Justin
Today is New Year's Eve! And we finally got an invite to an exclusive Swedish party in Moshi. As hard as it was, we stood them up. This is mostly because we had a better offer - a New Year's party with a doctor from the hospital, his friends and family. I later realised that it was actually a baptism. Altough I probably should've guessed this since he told us to meet him at a church at 10am...
We actually didn't know the name of the docor who invited us to his place to celebrate the christening of his granddaughter. All we know is that he travelled to Australia a few years ago and was very impressed with the generosity and hospitality of Australians. So he wanted to return the favour!
This morning was going pretty well as our rooster alarm clock woke us up. I swear he must be blind though, because he crows all bloody day! We woke up early to get ready. But Ally soon called Michael. We were now running late. Talking to Michael while he was on the phone was like talking to a patient having a 30 minute absence seizure. Nothing goes in.
Again I had no breakfast as the Swedish girls had taken my bananas. They had also taken the rest of my water and toilet paper. I thought we would get robbed by some locals in Arusha, not two retarded Swedish girls.
So after skipping breakfast we walked down the hill to the markets. On our way we saw someone wearing a helmet when riding his motor bike. First helmet sighting in 3 weeks. We missed the entire church service apart from the last 5 mins...thanks Ally. The doctor then took us to his house right in the middle of the village. He showed us around his extensive garden - he has heaps of banana trees, coffee trees and paw paws. And after Michael spilt 2 drinks and called his grand-daughter a boy...we were off to a good start.
The party was supposed to start at 11am, but because this is Tanzania...it started at 4pm. Over 150 guests came over for the party, most of them were hours late.
The food was amazing. We had goat, banana stew, heaps of rice and meat (for a change)...and this deceiving sauce which turned out to be the most spicy thing I've ever had. It destroyed my tongue and bowels.
We met heaps of locals our age. One girl was quite a character. She invited us to a New Year's party in Moshi..but after realising Michael has a girlfriend and I was catholic, she ditched us. Snob.
The day was pretty relaxed though. We just sat in a rainforest drinking Amurula listening to African music. It was also great to hear from all my friends and Michael's family that New Years was as enjoyable back home as it was here.
By the end of the night we still had no clue what the doctors name was. But after overhearing someone call him 'Dr Masawe'...we just assumed this was his name...we hope. Before he took us home, he took a leak in his garden...like all good consultants would.
We then went back to our dorm, crahed a local student party, left when we found out they were a cult and went home to count down to midnight. A great way to welcome the New Year.
Justin
Day 19 - He needs multivitamins stat
Fri 30th Dec 2011
Another day waking up in Machame, except this morning it was raining. I was way too tired to go to chapel this morning, so after the best sleep in, I decided to get ready for the hospital. Unfortunately there is no washing machine, and I have to wash my clothes by hand. The most recent load went mouldy, and as we have 1 bucket to share between 4 people... I can't wash my clothes again until Sunday! FML
So after wearing the same, stinking clothes for the past 3 weeks, I went to the outpatient clinic. When we got their this morning the nurses told us that the 'floor was too wet for clinic'....so we had to wait for the floor to dry.
After waiting back at our house with fantastic Swedish company (they can be so delightful sometimes)...I met up with the doctor in clinic. Her name was Dr Minja, and no I'm not joking. As funny as her name is, we did see some amazing cases.
The morning list started with a pregnant female who complained of 'body malaise'...Dr Minge diagnosed this as malaria. She was right. For the pregnant women, they don't say how far along they are. They write down... 'Patient complains of 5 months of amenorrhoea'.
The doctors have to be really knowledgable. They don't have access to specialists and can't make any referrals. They pretty much do everything- obstetrics, general medicine, paediatrics, heaps of general surgery and orthopaedics. They also don't have any access to cultures here. So they can only do a urinalysis dipstick and stool microscopy. They diagnose UTIs and gastro based on the micro result. The blood tests do come back pretty quickly... like within 1 hour for routine tests. Even the obstetric ultrasound comes back quickly.
They love the multivitamins here. A 95 year old male came in with 'unable to stand for a year'. So they prescribed multivitamin, 2 tablets for 5 days. How about checking his legs?!
So a few things went wrong today. After cannulating a female with an acute abdomen, the nurse dropped the needle on the floor and left. I noticed it some time later and told Dr Minja. She is the type of person who hates to get her hands dirty ... So as I expected she freaked out! She doesn't even own a stethoscope. She says she lost it...but I think she threw it away after it got contaminated. Maybe a patient touched it?
Michael also had an interesting morning. He managed to stumble across an emergency resuscitation of an unconscious patient. And discovered first hand how inefficient and ineffective a Tanzanian emergency department is...especially as it consists of just a corridor inside the outpatient department. After 15 attempts at cannulating him..a doctor finally came and put one in. Unlike 3 mins for a MET team to arrive back home...it took 1 hour for the first doctor to arrive. It took 2 hours for him to get to ICU.... where he was finally given oxygen. He must have been the first patient for a while to be given oxygen...as they had to use a spanner to turn on the oxygen cylinder. Ah Tanzanian time.
After such an entertaining and educational morning Michael and I went for a long walk to the local orphanage. The Neema Orphanage is located north of Machame. It houses around 50 children without mothers (orphans are allowed to have fathers here), aged between 4 months to 5 years old. We came and brightened their day with lollies (pi pi in Kiswahili)...but the carers wouldn't let us give the children lollies until they finished their fruit. As soon as they finished they raced to get some 'pi pi'...and even tried to eat the wrapper. They must've been pretty hungry. It was a great experience visiting an African orphanage, playing with the very cute kids and we are looking at helping the orphanage with our fundraising efforts.
Living here, we now know what it's like being an international student like Yang. It's weird when people call us international students... Mostly because I'm not Asian and don't spend my weekends in the Barr Smith library studying. We have though been eating heaps of rice though...
Justin
Another day waking up in Machame, except this morning it was raining. I was way too tired to go to chapel this morning, so after the best sleep in, I decided to get ready for the hospital. Unfortunately there is no washing machine, and I have to wash my clothes by hand. The most recent load went mouldy, and as we have 1 bucket to share between 4 people... I can't wash my clothes again until Sunday! FML
So after wearing the same, stinking clothes for the past 3 weeks, I went to the outpatient clinic. When we got their this morning the nurses told us that the 'floor was too wet for clinic'....so we had to wait for the floor to dry.
After waiting back at our house with fantastic Swedish company (they can be so delightful sometimes)...I met up with the doctor in clinic. Her name was Dr Minja, and no I'm not joking. As funny as her name is, we did see some amazing cases.
The morning list started with a pregnant female who complained of 'body malaise'...Dr Minge diagnosed this as malaria. She was right. For the pregnant women, they don't say how far along they are. They write down... 'Patient complains of 5 months of amenorrhoea'.
The doctors have to be really knowledgable. They don't have access to specialists and can't make any referrals. They pretty much do everything- obstetrics, general medicine, paediatrics, heaps of general surgery and orthopaedics. They also don't have any access to cultures here. So they can only do a urinalysis dipstick and stool microscopy. They diagnose UTIs and gastro based on the micro result. The blood tests do come back pretty quickly... like within 1 hour for routine tests. Even the obstetric ultrasound comes back quickly.
They love the multivitamins here. A 95 year old male came in with 'unable to stand for a year'. So they prescribed multivitamin, 2 tablets for 5 days. How about checking his legs?!
So a few things went wrong today. After cannulating a female with an acute abdomen, the nurse dropped the needle on the floor and left. I noticed it some time later and told Dr Minja. She is the type of person who hates to get her hands dirty ... So as I expected she freaked out! She doesn't even own a stethoscope. She says she lost it...but I think she threw it away after it got contaminated. Maybe a patient touched it?
Michael also had an interesting morning. He managed to stumble across an emergency resuscitation of an unconscious patient. And discovered first hand how inefficient and ineffective a Tanzanian emergency department is...especially as it consists of just a corridor inside the outpatient department. After 15 attempts at cannulating him..a doctor finally came and put one in. Unlike 3 mins for a MET team to arrive back home...it took 1 hour for the first doctor to arrive. It took 2 hours for him to get to ICU.... where he was finally given oxygen. He must have been the first patient for a while to be given oxygen...as they had to use a spanner to turn on the oxygen cylinder. Ah Tanzanian time.
After such an entertaining and educational morning Michael and I went for a long walk to the local orphanage. The Neema Orphanage is located north of Machame. It houses around 50 children without mothers (orphans are allowed to have fathers here), aged between 4 months to 5 years old. We came and brightened their day with lollies (pi pi in Kiswahili)...but the carers wouldn't let us give the children lollies until they finished their fruit. As soon as they finished they raced to get some 'pi pi'...and even tried to eat the wrapper. They must've been pretty hungry. It was a great experience visiting an African orphanage, playing with the very cute kids and we are looking at helping the orphanage with our fundraising efforts.
Living here, we now know what it's like being an international student like Yang. It's weird when people call us international students... Mostly because I'm not Asian and don't spend my weekends in the Barr Smith library studying. We have though been eating heaps of rice though...
Justin
Day 18 - Hakuna shida
Thurs 29th Dec 2011
After a very amusing evening of listening to Justin sleeptalk, we spent today on outreach. This essentially involved jumping in a minibus and driving to a decommissioned church in southern Machame to set up a clinic for the day. It had three parts - there was a primary care clinic, a dispensary and an HIV testing station.
They don't have GPs here in Tanzania, so the hospital runs primary care clinics like this to help give medical care to people who aren't sick enough to need hospitalisation. And it's all free, which is very good news for the locals.
We got to take histories from quite a lot of patients and, because pretty much no one spoke English, we had to do it all in Kiswahili! Although this was tricky, we were able to get by with a little help. Every history would start with the same three questions:
1. 'Jina laku nani?' - 'What is your name?'
2. 'Una miaka mingapi?' - 'How old are you?'
3. 'Una shida gani?' - 'What seems to be the problem today?'
Then we just had to listen to some key words to work out if the problem was with the belly (turbo), chest (kifua) or head (kichwa). So if the problem was something else, the patient was in trouble!
Although we managed to do most of it ourselves, luckily we had someone on hand to take over if things got too difficult to understand. There are only about ten doctors in Machame Hospital, so much of the initial care of patients is done by a 'clinical officer' instead. These people study a condensed medical course for three years and then work kind of like GPs. Except they're not so good.
They don't take a very thorough history and rarely examine the patient. A diagnosis is usually made after one question, and it's often quite wrong. So chest pain = pneumonia, tummy pain = worms, malaise = malaria and joint pain = rheumatoid arthritis. And most things are treated with multivitamins.
We were able to do our own prescribing today for the first time ever and even correct the clinical officer's prescribing, who tried to give diclofenac for a renal failure patient.
The other part of the clinic today was the HIV testing, which was done through a fingerprick blood test. The weird thing was that it was all very secretive, as everyone is really scared about having HIV and they don't want to be seen anywhere near an HIV testing area because their friends might see them and assume they have Aids. So the testing area was tucked away at the back and was never mentioned by name. So you don't tell the patients what's happening, as they (hopefully) already know.
It is by far the best feeling to be able to tell someone they don't have HIV ("hakuna shida"). People are so happy - like the lady who hugged Justin after he told her she was clear! In a beautiful moment of symmetry to the last HIV clinic I went to, I saw another grandma who brought in her grandchild who had lost its mother from Aids. But this time the baby was negative and she started crying with joy when I told her the news. We were really lucky today there were no new cases of HIV made.
The only not so good thing is that because of all the stigma and reluctance to talk about HIV, there is no counselling of the patients about how to avoid getting infected or primary prevention of any kind. We feel that the education about Aids is quite lacking here, which surely doesn't help the problem at all.
The last part of the outreach clinic was the dispensary, which was kind of a makeshift pharmacy where they give out all the medictions. They can only take a very limited range of drugs with them, so it made it hard to always prescribe what we wanted when we were seeing the patients.
They buy the tablets in bulk and then count out the number of tablets each patient needs from a big bottle and then put them in a plastic bag for the patient to take home. So there are no labels and the patients have no idea what they are taking. They are not told about side effects and only instructed about how many they should take each day. The interesting about healthcare here is that patients always expect to be given a drug when they come to see a doctor, partly why so many multivitamins were given out.
We went home and cooked banana (ndizi) pizzas, which is the Tanzanian specialty.
Today was actually a really good day as we got to do some real medicine! Not convinced that each patient got the best possible care, but at least it was better then nothing (except for the renal failure guy who got NSAIDS).
Asanteni sana,
Michael
After a very amusing evening of listening to Justin sleeptalk, we spent today on outreach. This essentially involved jumping in a minibus and driving to a decommissioned church in southern Machame to set up a clinic for the day. It had three parts - there was a primary care clinic, a dispensary and an HIV testing station.
They don't have GPs here in Tanzania, so the hospital runs primary care clinics like this to help give medical care to people who aren't sick enough to need hospitalisation. And it's all free, which is very good news for the locals.
We got to take histories from quite a lot of patients and, because pretty much no one spoke English, we had to do it all in Kiswahili! Although this was tricky, we were able to get by with a little help. Every history would start with the same three questions:
1. 'Jina laku nani?' - 'What is your name?'
2. 'Una miaka mingapi?' - 'How old are you?'
3. 'Una shida gani?' - 'What seems to be the problem today?'
Then we just had to listen to some key words to work out if the problem was with the belly (turbo), chest (kifua) or head (kichwa). So if the problem was something else, the patient was in trouble!
Although we managed to do most of it ourselves, luckily we had someone on hand to take over if things got too difficult to understand. There are only about ten doctors in Machame Hospital, so much of the initial care of patients is done by a 'clinical officer' instead. These people study a condensed medical course for three years and then work kind of like GPs. Except they're not so good.
They don't take a very thorough history and rarely examine the patient. A diagnosis is usually made after one question, and it's often quite wrong. So chest pain = pneumonia, tummy pain = worms, malaise = malaria and joint pain = rheumatoid arthritis. And most things are treated with multivitamins.
We were able to do our own prescribing today for the first time ever and even correct the clinical officer's prescribing, who tried to give diclofenac for a renal failure patient.
The other part of the clinic today was the HIV testing, which was done through a fingerprick blood test. The weird thing was that it was all very secretive, as everyone is really scared about having HIV and they don't want to be seen anywhere near an HIV testing area because their friends might see them and assume they have Aids. So the testing area was tucked away at the back and was never mentioned by name. So you don't tell the patients what's happening, as they (hopefully) already know.
It is by far the best feeling to be able to tell someone they don't have HIV ("hakuna shida"). People are so happy - like the lady who hugged Justin after he told her she was clear! In a beautiful moment of symmetry to the last HIV clinic I went to, I saw another grandma who brought in her grandchild who had lost its mother from Aids. But this time the baby was negative and she started crying with joy when I told her the news. We were really lucky today there were no new cases of HIV made.
The only not so good thing is that because of all the stigma and reluctance to talk about HIV, there is no counselling of the patients about how to avoid getting infected or primary prevention of any kind. We feel that the education about Aids is quite lacking here, which surely doesn't help the problem at all.
The last part of the outreach clinic was the dispensary, which was kind of a makeshift pharmacy where they give out all the medictions. They can only take a very limited range of drugs with them, so it made it hard to always prescribe what we wanted when we were seeing the patients.
They buy the tablets in bulk and then count out the number of tablets each patient needs from a big bottle and then put them in a plastic bag for the patient to take home. So there are no labels and the patients have no idea what they are taking. They are not told about side effects and only instructed about how many they should take each day. The interesting about healthcare here is that patients always expect to be given a drug when they come to see a doctor, partly why so many multivitamins were given out.
We went home and cooked banana (ndizi) pizzas, which is the Tanzanian specialty.
Today was actually a really good day as we got to do some real medicine! Not convinced that each patient got the best possible care, but at least it was better then nothing (except for the renal failure guy who got NSAIDS).
Asanteni sana,
Michael
Day 17 - These ward rounds never end...
Wed 28th Dec 2011
We got a lot done today - ward rounds with ICU, paediatrics, orthopaedics and then surgery.
We started the day with an ICU ward round. As Michael has already described, the ICU is basically just like a normal ward but only has 4 beds. There is no oxygen, no ventilators, and no barrier nursing. Most of the cases we saw today were severe pneumonia and asthma. For pneumonia, treatment is just penicillin. They don't have the facilities to do blood cultures, throat swabs and cultures. Only a chest xray. And monitoring these patients is quite different to back home. For the pneumonia case, they don't even listen to the chest.
After such a busy ICU morning we went on ward rounds with the paediatrician who has been on a non-authorised holiday for the whole time we've been here. We saw a few interesting cases, including malaria in a 12 month old girl and idiopathic lymphadenopathy.
When the consultant goes on ward rounds, he has no patient list. He goes to every ward in the hospital and asks the nurses if there are any patients for him to see. Luckily there are only 10 wards.
Surgical ward rounds were next. There was a diabetic patient with a 2 year old non-healing ulcer on his ankle. After removing the dirty socks he used to cover the wound, I saw the biggest tropic ulcer eroding bone. This was quite shocking!
The wards are very basic. Around 15 beds, crammed into a small room. The windows, if not smashed, are always open. The room is filled with heaps of flies and mozzies. The floor is always wet and sometimes there are needles lying around. Some beds are broken and held up with chairs.
We saw another case of a oldish female with a pelvic mass and ascites. A diagnosis of ovarian cancer was given, but because they have no way to confirm the diagnosis with biopsies... they just treat it as cancer. Palliative care here is also under resourced and patients really only get pain relief. Chemotherapy isn't available in northern Tanzania... so all patients have to travel to Dar es Salaam which is 9 hours by bus to get treatment.
The last case we saw really annoyed me. A female of 37 years presented with severe abdominal pain. She was short of breath at rest, and looked very ill. Her last LMP was over 6 weeks ago and I asked if she could be pregnant. The doctor told me that because her last period was 6 weeks ago, she couldn't be pregnant. So a -2 on SCT? Devitt would cry if he saw the management of this case.
We had a really long and tedious day.
Justin
We got a lot done today - ward rounds with ICU, paediatrics, orthopaedics and then surgery.
We started the day with an ICU ward round. As Michael has already described, the ICU is basically just like a normal ward but only has 4 beds. There is no oxygen, no ventilators, and no barrier nursing. Most of the cases we saw today were severe pneumonia and asthma. For pneumonia, treatment is just penicillin. They don't have the facilities to do blood cultures, throat swabs and cultures. Only a chest xray. And monitoring these patients is quite different to back home. For the pneumonia case, they don't even listen to the chest.
After such a busy ICU morning we went on ward rounds with the paediatrician who has been on a non-authorised holiday for the whole time we've been here. We saw a few interesting cases, including malaria in a 12 month old girl and idiopathic lymphadenopathy.
When the consultant goes on ward rounds, he has no patient list. He goes to every ward in the hospital and asks the nurses if there are any patients for him to see. Luckily there are only 10 wards.
Surgical ward rounds were next. There was a diabetic patient with a 2 year old non-healing ulcer on his ankle. After removing the dirty socks he used to cover the wound, I saw the biggest tropic ulcer eroding bone. This was quite shocking!
The wards are very basic. Around 15 beds, crammed into a small room. The windows, if not smashed, are always open. The room is filled with heaps of flies and mozzies. The floor is always wet and sometimes there are needles lying around. Some beds are broken and held up with chairs.
We saw another case of a oldish female with a pelvic mass and ascites. A diagnosis of ovarian cancer was given, but because they have no way to confirm the diagnosis with biopsies... they just treat it as cancer. Palliative care here is also under resourced and patients really only get pain relief. Chemotherapy isn't available in northern Tanzania... so all patients have to travel to Dar es Salaam which is 9 hours by bus to get treatment.
The last case we saw really annoyed me. A female of 37 years presented with severe abdominal pain. She was short of breath at rest, and looked very ill. Her last LMP was over 6 weeks ago and I asked if she could be pregnant. The doctor told me that because her last period was 6 weeks ago, she couldn't be pregnant. So a -2 on SCT? Devitt would cry if he saw the management of this case.
We had a really long and tedious day.
Justin
Day 16 - Fireflies stuck in that big blueish-black thing
Tues 27th Dec 2011
We're getting rather a lot of practice at the extremely fun game of 'spot the doctor' each morning, which is like a real life version of Where's Wally except you look for a white coat instead of red and white stripes. The doctors here have an uncanny knack of all vanishing after the morning meeting finishes and when the actual doctor work would be expected to begin. Nothing (ward rounds, clinics, theatre) is scheduled for any particular time, so it's really pot luck to be in the right place at the right time when something's going on.
So today we failed to spot any white coats at all and eventually decided to hang out with the midwives instead. This was something we had yet to experience in Africa, so things worked out pretty well. There were two preggos in labour today and we were able to follow them all the way to the births.
The first thing that struck us about the labour ward was just how many moths were in there. As any mother will tell you, labour takes aaaaages so there was quite a lot of time for us to dedicate to concerted counting of these creatures. We got to about 213 before it all became too hard/boring and gave up. So rather a lot of moths then.
Apart from the wildlife, the other big difference to Australia is that there is no pain relief offered for labour. It's not that they can't (epidurals are done for c-sections on pretty much a daily basis), it's just that it is not considered okay. Also, the women aren't allowed to have anyone present from their families, so husbands and other family members have to hang out around the hospital's gardens. Expectant mothers have to be tough cookies here in Africa!
Unfortunately, both mothers went into obstructed labour and had to be taken for caesarean sections. At least this time they were given an epidural! There were flies inside of the operating thaetre, which was at least a bit of variation to the moths.
The second case was quite confronting, as the patient was only 14 years old. Something that would surely necessitate a police investigation in Australia! Even worse, she almost lost her baby before she could even hold it. The baby came out with an Apgar score of about 3 and needed resuscitation. This was challenging because there was no oxygen and the nurse clearly hadn't had much training in CPR. We were really scared the baby was going to die and weren't able to intervene. Thankfully, both mother and baby are doing well now.
Next we went for lunch, which has become a bit like deja va as there is only one thing on the hospitals's menu. Cleary there are a lot of glitches in the Matrix in this part of the world. The dish is called pilau, which is basically rice and chunks of sinew with a little bit of meat that gets stuck in your teeth. So living here is sort of like being an enforced vegetarian, which hurts considerably.
After pilau, I spent the evening by absolutely destroying Justin in both yahtzee and several games of chess, so basically this was the best day ever.
Kwa heri,
Michael
We're getting rather a lot of practice at the extremely fun game of 'spot the doctor' each morning, which is like a real life version of Where's Wally except you look for a white coat instead of red and white stripes. The doctors here have an uncanny knack of all vanishing after the morning meeting finishes and when the actual doctor work would be expected to begin. Nothing (ward rounds, clinics, theatre) is scheduled for any particular time, so it's really pot luck to be in the right place at the right time when something's going on.
So today we failed to spot any white coats at all and eventually decided to hang out with the midwives instead. This was something we had yet to experience in Africa, so things worked out pretty well. There were two preggos in labour today and we were able to follow them all the way to the births.
The first thing that struck us about the labour ward was just how many moths were in there. As any mother will tell you, labour takes aaaaages so there was quite a lot of time for us to dedicate to concerted counting of these creatures. We got to about 213 before it all became too hard/boring and gave up. So rather a lot of moths then.
Apart from the wildlife, the other big difference to Australia is that there is no pain relief offered for labour. It's not that they can't (epidurals are done for c-sections on pretty much a daily basis), it's just that it is not considered okay. Also, the women aren't allowed to have anyone present from their families, so husbands and other family members have to hang out around the hospital's gardens. Expectant mothers have to be tough cookies here in Africa!
Unfortunately, both mothers went into obstructed labour and had to be taken for caesarean sections. At least this time they were given an epidural! There were flies inside of the operating thaetre, which was at least a bit of variation to the moths.
The second case was quite confronting, as the patient was only 14 years old. Something that would surely necessitate a police investigation in Australia! Even worse, she almost lost her baby before she could even hold it. The baby came out with an Apgar score of about 3 and needed resuscitation. This was challenging because there was no oxygen and the nurse clearly hadn't had much training in CPR. We were really scared the baby was going to die and weren't able to intervene. Thankfully, both mother and baby are doing well now.
Next we went for lunch, which has become a bit like deja va as there is only one thing on the hospitals's menu. Cleary there are a lot of glitches in the Matrix in this part of the world. The dish is called pilau, which is basically rice and chunks of sinew with a little bit of meat that gets stuck in your teeth. So living here is sort of like being an enforced vegetarian, which hurts considerably.
After pilau, I spent the evening by absolutely destroying Justin in both yahtzee and several games of chess, so basically this was the best day ever.
Kwa heri,
Michael
Day 15 - What happens in Moshvegas
Mon 26th Dec 2011
Today was Boxing Day here in Machame! As our alarms failed us again this morning, we rushed to the hospital being 30 mins late. Unfortunately, we discovered there was no chapel or any doctors at the hospital. So I guess another day off!
We decided to go to Moshi to buy food, as we had none left. We also needed currency and beer. Again we took the dalla dalla, which is a local minibus. They crammed about 32 people on..but there are rumours around this place that up to 43 passengers have fit into this tiny van. Everyone stares at us because we look different.
Once we got to Moshi we set out to complete our list of things to do. We did not get much done. Moshi smells really bad, and it was so hot! We got some supplies, checked our emails and got some shillings.
After another pilau lunch we settled back in our dorm. Once the other students returned from the local swimming pool....they were expecting dinner. So we reluctantly made some rice. We had to pick out all the bark and wood, which took hours. The rice did taste amazing though, so I thought we did a good job.
Today was another short day. But a good chance to catch up on stuff I haven't done for ages, like taking a shower or washing my clothes. I really do miss having a washing machine my dad uses to clean my clothes. So today I washed my clothes in a small tub of dirty water, under the harsh African sun.
Apart from a little banter, today was mediocre.
Justin
Today was Boxing Day here in Machame! As our alarms failed us again this morning, we rushed to the hospital being 30 mins late. Unfortunately, we discovered there was no chapel or any doctors at the hospital. So I guess another day off!
We decided to go to Moshi to buy food, as we had none left. We also needed currency and beer. Again we took the dalla dalla, which is a local minibus. They crammed about 32 people on..but there are rumours around this place that up to 43 passengers have fit into this tiny van. Everyone stares at us because we look different.
Once we got to Moshi we set out to complete our list of things to do. We did not get much done. Moshi smells really bad, and it was so hot! We got some supplies, checked our emails and got some shillings.
After another pilau lunch we settled back in our dorm. Once the other students returned from the local swimming pool....they were expecting dinner. So we reluctantly made some rice. We had to pick out all the bark and wood, which took hours. The rice did taste amazing though, so I thought we did a good job.
Today was another short day. But a good chance to catch up on stuff I haven't done for ages, like taking a shower or washing my clothes. I really do miss having a washing machine my dad uses to clean my clothes. So today I washed my clothes in a small tub of dirty water, under the harsh African sun.
Apart from a little banter, today was mediocre.
Justin
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