Yesterday, I left the town of Shirati to make my way to the 2nd largest town in Tanzania, Mwanza. I got a ride in the hospital car to the next major city, Musoma. As I was getting out of the car, a police officer ticketed the driver since he hadn’t “parked” in an appropriate stop. Instead, he had stopped the car on the side of the road and I was just getting off. More drama than was necessary. I wonder if he only got ticket, because as a foreigner coming out of a Land Cruiser, I was an easy target. The funny thing was, the police officer actually got into the car with the driver and they drove off to the station. I feel like having been in Shirati, I was so far removed from the corruption and politics of the developing world. In general people are too poor to be able to pay a bribe.
My last week at the hospital went by extremely quick. I was covering the female ward for another doctor who was at a TB and leprosy training. I also had the chance to visit a US family doctor who has recently set up a local primary care clinic in a small village about 6 km out of Shirati. It was heartbreaking in a sense, because I realize the conflict that arises from wanting to be the family doc who “does it all.” In a sense, the interventions that are most needed, take little training and would be best addressed by a traditional birth attendant or community health worker. For example, the childhood vaccine clinic only makes it to the village once a month, antenatal and basic childhood health care goes a long way here.
Not all is ill fated in Tanzania. As I travel, I’m seeing signs of wealth, thriving businesses and infrastructure that is likely making lives easier at every step. Everyone here has a cell phone. I can’t imagine it was a simple accomplishment, but it seems to have made the world much smaller. In addition, paved roads seem to be making travel a lot easier and even internet cafes are popping up, filled with local Tanzanians, instead of just tourists.
Tomorrow, I’ll be in Moshi, just under Mt. Kilimanjaro, visiting a clinical site run by the Pediatrics AIDS corps.
Best wishes to all…
Tuesday, April 22, 2008
Sunday, April 13, 2008
Visiting Musoma
This last week, Dr. Chirangi, the physician who invited me to Tanzania has been visiting the hospital. He is finishing up a public health degree in Holland. We have come to Musoma (the regional headquarters) about 2 hours from Shirati. It is the city where Dr. Chirangi grew up.
I'm traveling with a large group of people, a women from Holland who has been here for 8 months, four Dutch nurses who are finishing up a 3 month stay at the hospital, and a missionary who is on his third year in Tanzania, two of which he and his family worked in Shirati.
The trip has been nice and relaxing. We have visited Dr. Chirangi's home, and had a wonderful meal. The food has been plentiful. No ones seems to serve the traditional "Ugali" to me. I'm told rice is considered more appropriate for a foreigner. As a result, I eat a lot of rice. Eggs, beans, cabbage, and spinach are plentiful. And fruit such as bananas, mangos, papayas and oranges are easy to find as well. In general though the cost of food is expensive, especially for local currencies.
Musoma is right on Lake Victoria so they have a busy ferry port with a market moving goods between Musoma and islands and other cities on the coast. The boats are leaky, colorful vessels that require constant bailing out of water. In addition, most people can't swim and the water if full of schistosomiasis. I'm trying to stay draw and out of the water.
Today we head home and I'm looking forward to the slow, relaxed pace of Shirati. The urban life, especially the pollution gets to me very quickly.
Best wishes to everyone, feel free to call any time.
I'm traveling with a large group of people, a women from Holland who has been here for 8 months, four Dutch nurses who are finishing up a 3 month stay at the hospital, and a missionary who is on his third year in Tanzania, two of which he and his family worked in Shirati.
The trip has been nice and relaxing. We have visited Dr. Chirangi's home, and had a wonderful meal. The food has been plentiful. No ones seems to serve the traditional "Ugali" to me. I'm told rice is considered more appropriate for a foreigner. As a result, I eat a lot of rice. Eggs, beans, cabbage, and spinach are plentiful. And fruit such as bananas, mangos, papayas and oranges are easy to find as well. In general though the cost of food is expensive, especially for local currencies.
Musoma is right on Lake Victoria so they have a busy ferry port with a market moving goods between Musoma and islands and other cities on the coast. The boats are leaky, colorful vessels that require constant bailing out of water. In addition, most people can't swim and the water if full of schistosomiasis. I'm trying to stay draw and out of the water.
Today we head home and I'm looking forward to the slow, relaxed pace of Shirati. The urban life, especially the pollution gets to me very quickly.
Best wishes to everyone, feel free to call any time.
Finding a place at the hospital.
Hey everyone,
It was so wonderful to talk to both sets of parents this weekend. Sorry, mom and dad Casanova I was still asleep from a late night out!
In any case the week has been exciting. I have a level of independence here at the hospital that is exciting and very challenging. I was called into an emergency surgery on Wednesday night. A women had a ruptured ectopic pregnancy. I'd seen the surgery done twice in the US, but both times the pregnancy had been detected before it ruptured. The doctors here helped me immensely and the surgery went very well.
The day before, however, I found myself in a cesarean section running into problem after problem. The suture string here is not attached to the needle so as I was trying to sew up the uterus, the needle kept on coming off my suture. In addition, of course, my suction was not working so it was impossible to see what I was doing. I felt terrible because it was nearly impossible to tell if I had stopped all the bleeding. We finished the surgery, but I had a guilty feeling that the surgery may not have gone well. I was comforted to see the women the next morning breast feeding a beautiful baby and her surgery seemed to have had no complications.
I think rounding on the children's ward is the most challenging job I have taken on. There is no designation of an ICU and there is only one nurse for all the patients, with the help of 1-2 nursing students. The most we have had is 20 children. Rounds in general involves asking some basic questions, mostly whether or not the mother thinks her baby has improved. There are very few laboratory tests to confirm what may be cancer or sepsis, you have to go entirely on the clinical picture. Since I'm so used to micromanaging sick children in the US, I find it very difficult to change my expectations of what I should be doing. As a result every morning I come to the hospital to find that one child, sometimes expected, sometimes not, has passed away.
The staff at the hospital has been so amazing. They love to learn and love to soak up knowledge. They also are generous in sharing information and teaching me about tropical disease, local feeding patterns, traditional medicine and various techniques of doing procedures.
In any case, I am finding that the challenges to health care in a rural community in Tanzania are only amplified in the hospital. Most of what I see is complications of preventable disease, Malaria, Pneumonia, Meningitis, some of which we have vaccines for in the U.S. But also, the number of patients showing up after watching a wound fester into gangrene or seeing HIV go to the level of wasting is tragic.
Finally, I've spent time with the well funded HIV clinic. They are able to give medicines for free. The number of people on antiretroviral medicines is about 800, with 1200 HIV positive people visiting the clinic monthly. The have an outreach worker who finds patients who miss appointments and they have 5-10 people coming to be tested every day. People are amazing at tacking their medicines. Almost no one misses a dose, and it seems inconceivable that so many people still lack treatment because of stigma, cost of care or lack of infrastructure.
In any case, I think I'm realizing that for all the procedures and surgical training I have, there is nothing that replaces a local health care provider in your community, that you can get to any time, and that will treat your problems early, with thoughtfulness and respect. I'm so glad I'm a family doctor.
It was so wonderful to talk to both sets of parents this weekend. Sorry, mom and dad Casanova I was still asleep from a late night out!
In any case the week has been exciting. I have a level of independence here at the hospital that is exciting and very challenging. I was called into an emergency surgery on Wednesday night. A women had a ruptured ectopic pregnancy. I'd seen the surgery done twice in the US, but both times the pregnancy had been detected before it ruptured. The doctors here helped me immensely and the surgery went very well.
The day before, however, I found myself in a cesarean section running into problem after problem. The suture string here is not attached to the needle so as I was trying to sew up the uterus, the needle kept on coming off my suture. In addition, of course, my suction was not working so it was impossible to see what I was doing. I felt terrible because it was nearly impossible to tell if I had stopped all the bleeding. We finished the surgery, but I had a guilty feeling that the surgery may not have gone well. I was comforted to see the women the next morning breast feeding a beautiful baby and her surgery seemed to have had no complications.
I think rounding on the children's ward is the most challenging job I have taken on. There is no designation of an ICU and there is only one nurse for all the patients, with the help of 1-2 nursing students. The most we have had is 20 children. Rounds in general involves asking some basic questions, mostly whether or not the mother thinks her baby has improved. There are very few laboratory tests to confirm what may be cancer or sepsis, you have to go entirely on the clinical picture. Since I'm so used to micromanaging sick children in the US, I find it very difficult to change my expectations of what I should be doing. As a result every morning I come to the hospital to find that one child, sometimes expected, sometimes not, has passed away.
The staff at the hospital has been so amazing. They love to learn and love to soak up knowledge. They also are generous in sharing information and teaching me about tropical disease, local feeding patterns, traditional medicine and various techniques of doing procedures.
In any case, I am finding that the challenges to health care in a rural community in Tanzania are only amplified in the hospital. Most of what I see is complications of preventable disease, Malaria, Pneumonia, Meningitis, some of which we have vaccines for in the U.S. But also, the number of patients showing up after watching a wound fester into gangrene or seeing HIV go to the level of wasting is tragic.
Finally, I've spent time with the well funded HIV clinic. They are able to give medicines for free. The number of people on antiretroviral medicines is about 800, with 1200 HIV positive people visiting the clinic monthly. The have an outreach worker who finds patients who miss appointments and they have 5-10 people coming to be tested every day. People are amazing at tacking their medicines. Almost no one misses a dose, and it seems inconceivable that so many people still lack treatment because of stigma, cost of care or lack of infrastructure.
In any case, I think I'm realizing that for all the procedures and surgical training I have, there is nothing that replaces a local health care provider in your community, that you can get to any time, and that will treat your problems early, with thoughtfulness and respect. I'm so glad I'm a family doctor.
Thursday, April 3, 2008
At the Hospital
I've made it to Shirati safely. what a journy. My plane out of Dar es Salaam, ended up leaving early so I had to shop to replace my clothing in about 30 minutes and get to the airport. Musoma airport is a tiny landing strip with a one room terminal for arriavals. It was definitely a small town airport.
The drive to Shirati was easy on mostly paved roads except for the last 40 kilometers. I'm staying in a house about 1/2 km behind the hospital. They have found a cook for me, so she makes my meals. Otherwise, I try to spend as much time in the hospital as possible to see and learn as much as I can.
The culture in the hospital is very slow here. Nothing is too urgent. Nothing happens fast. People work from 9am to 2:30 pm so it is not nearly as intense as I am used to in residency. I was in the operating room on Tuesday and saw a good number of cases and have been rounding on the pediatrics service since yesterday.
Tomorrow I'm going to visit with the HIV testing folks and see what they do. I haven't made it to labor and delivery yet, but it seems like most of the deliveries are handled by the nurses, unless there is a c-section.
The town of shirati is small, quiet and along the lake, so Malaria is a big problem. Electricity is come and go, but my cell phone works great. Actually, I have never seen such a thriving cell phone system, I think AT&T could learn a thing or two.
My love to everyone, I'll try to keep in touch and post something every few days.
The drive to Shirati was easy on mostly paved roads except for the last 40 kilometers. I'm staying in a house about 1/2 km behind the hospital. They have found a cook for me, so she makes my meals. Otherwise, I try to spend as much time in the hospital as possible to see and learn as much as I can.
The culture in the hospital is very slow here. Nothing is too urgent. Nothing happens fast. People work from 9am to 2:30 pm so it is not nearly as intense as I am used to in residency. I was in the operating room on Tuesday and saw a good number of cases and have been rounding on the pediatrics service since yesterday.
Tomorrow I'm going to visit with the HIV testing folks and see what they do. I haven't made it to labor and delivery yet, but it seems like most of the deliveries are handled by the nurses, unless there is a c-section.
The town of shirati is small, quiet and along the lake, so Malaria is a big problem. Electricity is come and go, but my cell phone works great. Actually, I have never seen such a thriving cell phone system, I think AT&T could learn a thing or two.
My love to everyone, I'll try to keep in touch and post something every few days.
Sunday, March 30, 2008
Weekend in Dar es Salaam
Hello from Dar!
As you have probably heard, I landed in Dar a-O.K. but my bag did not arrive with me. However, I'm being hosted by the most wonderful family, so the weekend has been a wonderful chance to relax and think about my upcoming adventure.
I arrived Friday morning, since I didn't have a bag, I hit the shops to buy some underwear and socks ($35 later...) I was hanging out a Liz and Hemen's house in the beautiful peninsula area just north of the city center. It is a gorgeous here and they have a wonderful house.
Over the last two days, I've been lounging at the pool, on the beach, I evev tried out sailing for the first time.
Liz and Hemen have two lovely girls, Zimi and Sanaya, who have been a great adventure in and of themselves.
Dar is a neat city. It has the dense urban city center, that is very reminiscent of India, but the sububarbs are full of large houses, with security gaurds, 4x4's, and lush gardens that remind me of Zambia. It does not have the dense urban feel of a lot of large cities and the rainy season has everything very green and lush.
Tomorrow I am off to Musoma (without my bag!) and will see the hospital. I can't wait.
Love you all,
Nishant
As you have probably heard, I landed in Dar a-O.K. but my bag did not arrive with me. However, I'm being hosted by the most wonderful family, so the weekend has been a wonderful chance to relax and think about my upcoming adventure.
I arrived Friday morning, since I didn't have a bag, I hit the shops to buy some underwear and socks ($35 later...) I was hanging out a Liz and Hemen's house in the beautiful peninsula area just north of the city center. It is a gorgeous here and they have a wonderful house.
Over the last two days, I've been lounging at the pool, on the beach, I evev tried out sailing for the first time.
Liz and Hemen have two lovely girls, Zimi and Sanaya, who have been a great adventure in and of themselves.
Dar is a neat city. It has the dense urban city center, that is very reminiscent of India, but the sububarbs are full of large houses, with security gaurds, 4x4's, and lush gardens that remind me of Zambia. It does not have the dense urban feel of a lot of large cities and the rainy season has everything very green and lush.
Tomorrow I am off to Musoma (without my bag!) and will see the hospital. I can't wait.
Love you all,
Nishant
Wednesday, March 19, 2008
One week and counting!
I am rapidly approaching my departure date on March 26th. The to-do-list is quickly shrinking, but I'm still in need of a Yellow Fever Vaccine, a flight from Dar es Salaam to Musoma, and then time to think about packing!
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