More tales of medical caravan week #1

Our second day was at a dispensary called Karmeli. It is essentially a medical outpatient building where the local medical officers would hold clinics and see patients one or two days a week. The medical officers are not quite doctors, more at the level of our nurses in Canada (or maybe even a bit less skilled). The dispensary is run by the Catholic Diocese (essentially an outpost extension of the Kilema hospital we are based at). It was a primitive building with one toilet (it flushed!!) and running water from two sinks...I should qualify this statement by telling you that several of the dispensaries we visited this week had no running water. One of them was a rural government hospital site that I feel sad discussing. I really can only describe it as the most destitute place I have ever seen. The outpatient building had no running water (which was bad enough because our Purell hand sanitizer was confiscated at the airport by the health Canada/Customs officials because it was 'out of date'. This is ridiculous because it is not a drug that we were planning to give to patients (just for use by ourselves!) but they had their rules and stuck to them. They check all of our 'bins' of supplies very carefully. There are strict rules about bringing expired medicines to Africa...the ethics of it is murky when many of the expiry dates are set way before things become expired and millions of dollars of medical supplies are discarded every year by wealthier countries around the world. Mafua was the name of this particularly poor dispensary with no water. The people who were in line when we arrived were also clearly much poorer than at the first two caravan stops. Mafua was deeper into the mountainous regions of Kilimanjaro and much more isolated. Along with the poverty of course meant much sicker people. As logistics was setting up our work stations, I walked through the inpatient ward with sister Clarissa. Sister is the director of the Kilema Hospital. She has worked tirelessly to set up all of our clinics for the Caravan ahead of time. She also arranged for a hot lunch to be brought to each site for us each day. Our staple has been rice with some sort of meat or a vegetable curry dish. Since I have sworn off meat in Tanzania, that means rice for lunch each day. For those who know me as the carbo loving woman that I am..this is just fine. I cannot adequately describe the inpatient ward of this hospital. It was located in a small decrepid building about 500 yards from the outpatient centre and 400 yards from the 3 pit latrine toilets. We all made a pact on arrival that none of us would use the toilets in Mafua in order to prevent us picking up disease and carrying it into the clinic (where we couldn't wash our hands) or back to Kilema. This meant take a sip of water when you are thirsty but don't guzzle! Those who were desperate wandered off to look for a private bush but, even though this is a rural part of Africa, that can be hard to do. People live in the bushes on small plots with shacks erected. Each plot is called a shamba and it is usually handed down through inheritance or by marriage. You might think you are in a private spot but there is a high probability that you could turn around and see a little kid sitting in the bushes staring at your behind.
The hospital was deserted with respect to any hospital workers/nurses/doctors. There just didn't seem to be any one looking after the patients. Sister and I found a baby (?10 or 11 months) sitting on the floor in the hospital hallway. He raised his arms for me to pick him up..she clicked her tongue and said "this my friend is what the Tanzanian government hospital system provides". There was a clear difference to the infrastructure at the Kilema hospital (which is supported in part by the Catholic Diocese) and what was available for sick people in the Mafua area. Sister said she came up the week before to speak to the head nurse to arrange our details for arrival at the clinic and again there was no one to be found. The nurse was later found sitting in someone's house with her child on her lap. When you are paid the equivalent of $5.00 per day it is hard to be motivated.
The cases I saw in Mafua were in keeping with previous clinic days but with many more truly sick people in line. Chris Fisher (our lead person) went through the line-up of more than 500 people at various times of the day to usher in the sick babies and the elderly. I saw several children who had come with their 'Bibi' (grandmother) and on questioning had no parents to be found. This is a big clue for HIV infection. Two of them had high fevers (one with pussy ears and throat and the other with what I thought was Malaria). Both had several of the signature HIV associated skin rashes as well. I treated their various ailments as best as I could and highly encouraged them to come to Kilema Hospital for an HIV test. One 11 year old girl came by herself in the dirtiest dress I had ever seen. She lined up all day and when I saw her she had a fever of a 104!. She said she lived with her Bibi (grandmother) who was unable to line up with her. She clearly had HIV (tell tale rahses) and was severely malnourished. She had tonsillitis and symptoms of hookworm. I treated both with the medications I had and sister Geraldine wrote instructions for her in Swahili on a piece of paper. I gave her medicine for the fever which she took on the spot and very willingly. I gave her a Kit Kat bar I had in my bag and got a huge smile....it broke my heart to see her go. I know the outcome won't be good over the long term.
My translator that day was sister Geraldine, one of the sisters from Kilema who has some medical training. She was a joy to work with. ..and very sweet. Every time I would see someone and send them off with their prescription sheet to take to our makeshift pharmacy to pick up their medicine she would touch my arm and say "Assante" which is Thank you in Swahili. She even got very good at deciphering 'sick versus not sick' as she heard each person's story. We saw a lot of women between the ages of 30 and 60 who of course are the work-horses of Tanzania. As I have said previously, Africa survives on the backs of hard working women who cook, clean, farm, look after children and often do all this with 40 or 50 pounds of stuff on their heads. Most of their complaints were not surprisingly neck pain, back pain, and sciatica. Pain relief is about all we can provide. Jenn Carpenter, my dear friend and another doc who is travelling on the mission with us, was stationed in a room with me yesterday and we had a moment of comic relief when I heard her say to her translator, tell her that her neck and back pain is from carrying too much stuff on her head, she needs to cut down on the head carrying!! I just burst out laughing, I can't ever see myself saying this to someone anywhere else but right here.
I will download some pictures of interesting diagnoses for those of you who like that kind of stuff...I just haven't found the camera connector thing yet.
Roman and Jack and Hannah arrive at Kilimanjaro Airport tonight...I am very excited.
I am on my way today to meet with our social worker Asha. She will prepare our Tanzanian homestudy for the adoption. The caravan is on today as well but I took the day off. Roman and I will both be working for 5 days on the next one that wil take place the last week of February and first week of March. Sister Clarissa has found a 'girl' to help out whith watching the kids while we are at the caravan sites. She will keep them busy and provide their lunch etc...
The pictures I have posted are of a child with mumps and one of John Cockburn (yes, related to Canada's Bruce) treating a baby. Also a pic of Kili in the morning, taken from Moshi as I waited for the bus to go and meet the social worker.