more moshi

Well, since my last post, lots of new experiences and no internet so here's a brief update:

1. Rounded on the pediatric ward (neonatal intensive care) and saw some really good care of some sick babies, many of the sickest born to moms with HIV.  One baby was abandoned by her mother for a reasons that the medical team was unsure about, though likely due to the financial and social stress of caring for a needy child.  They will try to find a family member and if this is unsuccessful, she will likely be given into custody of social services.  Adoption is possible though infrequent.  On a better note, all of the babies we delivered earlier in the week for a variety of complications were doing well.

2. Spent the day at a local district hospital.  When they heard I was a doctor, I got the grand tour, met every medical person here.  "Please come back Doktari" was the common request.  Most of the hospital (busier than Duke and KCMC) is staffed by mid-level providers (like PAs) who do cesarean sections and run the wards.   Patients must come here to be evaluated before being transferred to a referral center like KCMC.  Anyway, I spent the day with some volunteers from a local NGO who accompanies patients from a certain rural village from the bus stop, to the hospital, to their appointments, to ordered tests, to pharmacy.  They also pay the minimal fees for any medications and the consultation (about 1.50) as well as transportation to and from the city.  Four of the patients were waiting to see the general surgeon who I had met in the ward earlier in my tour.  He had about 40 patients in line when he finally arrived at his office at 10:30 or 11 (first come, first serve).  Since the volunteer who was with me was busy with some other patients, I went in to see him with the last two.  The volunteer arrived in the middle and he said it was amazing to see the difference in attention to these patients when a doctor was there.  He actually made a big deal about explaining things to them and discussing follow-up with me.  He went so far as to give the volunteer his cell phone number....frustrating that everyone does not get careful care.  This happens at home too (for VIPs v. poor patients).

3. Did a walking safari.  Yes, we walked around a local national park with an armed park ranger.  It was exciting at times (approaching the male buffalos who had been kicked out of the herd temporarily).  Most times, it was just beautiful--mountains, green, watery fields.  We saw many buffalo and warthogs but also saw some beautiful giraffes, zebras and a few monkeys.  I got to "swim" a bit under a beautiful waterfall as well.  Finally, we ended the day with perhaps the most dangerous part--riding home in a minibus squeezed in with 40 or so passengers traveling down one of the most accident prone highways in the world....scary, when you have no hold on anything and the bus is passing the care in front with oncoming traffic.  Well, obviously I survived.

4. Today I rounded on gyn with the residents and it was fun to interact with one of the very good residents here in a way that was beneficial to us both.  I had a bit more confidence about treatment than him (since I am a year ahead and this is his first gyn rotation) and he knew more about resources available to patients.  Also, like me he did not speak Kiswahili so we muddled through together with two really good interns helping out.

community

Luckily for my brain and my body, there is not much for me to do here.  I never remember how much I like being busy until I am not.  It is strange to be right next door to labor and delivery and not be able to do anything to help out.  This is actually a good thing for me....a rest.

As far as traveling goes, I spent Monday morning visiting some women in the villages around Moshi.  A friend here is doing a research project that involves asking women about their birth experiences whether in the hospital or at home.  We spoke with a really sweet, laughing woman who could not say anything bad about her experience.  She laughed at everything--especially at herself when she could not sign her name.  She had never been to school.  I could not decide if she was ashamed and the laughter was a cover-up or whether she truly was happy and able to see the good in life.  It is certainly a gift to be able to do that.  Of course, her daughter (1 year old ) was fat and healthy.  Then, we went to another village and tried to find the woman we were to interview but this proved more difficult because people in that village were fairly suspicious of us two white people (mazungu) even though we were with a Tanzanian grandmother.  We did not really get anywhere.  I was sorry because I thought maybe it was made worse because I was there.  In any case, it makes me realize that to really get to know a community and to gain their trust, takes time and persistence.  

Yesterday, we visited a beautiful little district hospital about 90 minutes from Moshi.  The pediatricians gave a lecture there to the staff and then we did some consults.  The labor ward was not busy and seemed uncomplicated but we saw 2 sick children that we brought back to KCMC with us for treatment.  One was 5 days old and likely suffered from asphyxia during a difficult delivery.  This can happen in the States too, but usually he would have gotten more intensive care earlier....and in this case, would have had a cesarean section.  His mom cried when she realized we were concerned....and we have no idea about the prognosis.  The other child was suffering (at 6 years old) from a complication of HIV.  He was so weak, he had to be carried by his mother.  It hurts to see children hurting.  

the weekend

Moshi is truly beautiful.   With Mt Kilimanjaro in the background every day, how could it not be.  I think the population here is pretty well-off as well.  Life here is actually pretty nice.  It feels like a vacation to me before going to Haiti.

It was a huge contrast to go to church today and see all these well-dressed people walking into the chapel when outside there were poor people waiting for health care or visiting their family members in the hospital.  It was also interesting to go from an African service directly to an English service (alot quieter).  There are so many humanitarian workers from all over the world here, including Tanzania and other African countries and everyone is asking themselves the same questions: how can we really help tanzania (or insert other developing country), how much should we give, how guilty should we feel for our lifestyle, how will change happen?

I think there is probably only one messy but true answer to all of these questions and I think it is Jesus Christ and his church.  What a privilege to know him---and to have a long time to learn his answers!!!

Tomorrow, I will get to spend time at the District Hospital and also in the village talking to a woman about health care.  I am looking forward to seeing that part of Moshi.

arriving in tanzania

I am here in Moshi. The weather is beautiful.  It is hot, but not so hot that I can't go running.  There is a great breeze.  Kilimanjaro is beautiful.  You can't always see it because of the clouds.  

So far, there have been many crazy things to hear about.  I can't do much because I don't have a license.  Actually, this is probably a good thing because I am enjoying having minimal responsibility.  Anyway, here at Kilimanjaro Christian Medical Center, we actually do have decent care for patients, BUT most patients who come here have to be referred from the local government hospital.  So, alot of the emergencies that transfer in are true emergencies and probably should have come here alot sooner.  

We have had several near misses for babies in the last few days but somehow they have all made it....so far.  We'll see what the weekend brings.  I have gotten to help out alot with resuscitating babies, which has been great since I barely get to touch them in the States.

This coming week, I am hoping to spend some time meeting some people in the village since I still am not sure what is going on with Tanzanians.  I spend all of my time so far with Americans and unfortunately I cannot speak Swahili.  Everyone I have talked to has been very interested in Obama however....

It is such a short visit!!!!

Beginning thoughts

After a busy year, I am finally ready to spend my little bit of free time during residency in Tanzania and Haiti. It is exciting and surreal. I am looking forward to time for reflection, being outside (even if it will be HOT!), and being reminded, I hope, of why I became a doctor.

Dad said in church today that he remembers me saying at 8 years old that I wanted to be a doctor in Africa. It's crazy to think that we never know what is really possible. We rarely believe that dreams or visions we have will actually happen. But, here I am, a doctor, for the first time going back to Africa....so, I guess, with God all things are possible.

I don't know if I feel like a great missionary at this point in my life. In fact, I feel like I need a missionary. I don't think this trip is so much about being able to do great things for people as it is about allowing me time for discernment about the future.