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