|Hamjambo! Habari na nyombani? Habari yako? Habari na kazi?
We could continue with our greetings for a good 5 minutes more in true Tanzanian style but need to rush before the next power failure, computer failure or before we melt in this heat!
We have been working at Tuele Hospital now for 3 weeks. I have taken on a paediatrics ward (of which there is two) and have had some major ups and downs! My first day involved a child dying despite resusitation due to severe anaemia/malaria. That was hard... what a start! Now.... unfortunately I am getting used to children dying. I have had two children die where I feel I have made a mistake (always easier to evaluate in retrospect) and possibly could have altered the outcome. But then, I try not to focus on these.
For those medically inclined: (otherwise read over quickly!)
I have had the opportunity to treat children with HIV, Burkitts Lymphoma, TB, severe Malaria, and severe malnutrition. We have access to HIV antibody tests, CD4 counts, Hb, Glucose, Blood/CSF cultures, Blood films for malaria and FBE.... however whether you should believe the result is another thing! I learnt the hard way of trusting the laboratory Hb, in that I didn't give blood to a child because their Hb was more than 5 but clinically looked anaemic and had respiratory distress. Unfortunately when retested 4 hours later, the Hb was 2.3 and the child died before getting some blood. This has been hard, especially in children with a borderline Hb, for example Hb of 5 (which if at home the child would get a transfusion immediately) but here depends on your clinical judgement. I now will give blood to any child that looks anaemic, has malaria, has respiratory distress and a Hb less than 6! Fiona's rules of anaemia. Although I do realise the risks of giving blood in this setting, as my patient Tabu is HIV positive yet her parents are negative and she has had 3 blood transfusions before. Therefore, like I said, its a difficult decision sometimes.
We have had a shortage of antibiotics for two weeks.... again making life difficult as I haven't been able to prescribe injectable Penicillin, Ampicillin or Chloramphenicol. The hospital is generally staffed by Clinical Health Officers, who have had two years of training, or Assistant Medical Officers, who have had a total of 4 years of training. Without the usual cocktail of gentamicin and ampicillin being available, I have had children admitted to the ward with some horrible combinations of antibiotics. I have been faced with the issue of changing these antibiotics to a more suitable regime, whilst trying not to "upset" the clinical officers here. They seem to take it personally when I have made changes to their prescriptions of drugs.... so I am learning about the difficulties of relationships in this setting. Plus being a young FEMALE doctor doesn't help the situation.
On a lighter note:
We were in our morning meeting yesterday and an awful smell kept wafting into the room. We were then informed that the mortuary has no refridgeration at the moment. Considering it is the end of Ramadan this weekend and the electrician is Muslim, I highly doubt this will be fixed before Monday. Yuck.
Nic has been busy with maintainence jobs around the hospital. He is currently working on emptying the store rooms, as there is a regular shipment from the UK twice a year. Unfortunately these supplies generally stay in the storeroom until things expire. So he has had the difficult job of distributing these supplies. Of course there is a protocol for getting items out of storage and everything and everybody moves slowly! Also, there are some strange items that get sent here - scrap paper, stents for cardiac surgery, expired warfarin! Nic also has a the task of driving children to school on Mondays to Tanga (1 hour away), which means that he gets to stock up on important food and alcohol for the week!
Our house is very comfortable with a veggie garden, a resident bush baby (like possum) and we have vervet monkeys that visit also. Our entertainment is the local water tap, situated in our yard, which has lots of people coming to fill tanks during the day before the water is turned off at 6pm. We are fortunate as we have a water storage tank so generally do not run out of water!
We have had the chance to "escape" from the hospital on our weekends, which are wednesdays and thursdays. Fi thought it best if she stayed for the weekends as there are generally only one doctor around on the weekend (if you are lucky). We have gone to the coast twice and wow, felt like rich tourists as we were surrounded with so much beauty and luxury! We have done some lovely snorkelling in a marine reserve off the coast. Drank wine and ate good food, and can't wait to return on wednesday! Our favourite place is called peponi (heaven in kiswahili) and here we can rent a tent, drink lots of wine, eat great food and relax relax relax....
Anyway, it is Idi today, end of Ramadam. We are happy about this as we have had continual chanting during the night for the last 3 weeks. Hopefully we will have a full night sleep tonight!
We haven't had the opportunity to check emails for some time. Sorry about that. If the power stays on, we'll hopefully get a chance today! Our thoughts are with you all and we send our love!
Fi and Nic