Caravan #2

Our caravan stops this week have been great. We had some visiting students (Brits, Germans and a lovely young medical student from St. John’s Newfoundland named Melissa Angel) join us from the Kilimanjaro Christian Medical Centre (KCMC) a fairly large hospital in Moshi. They seemed to enjoy the day that they spent with our group. I have to say that after you spend a few days with complete strangers who all have a very like-minded purpose, you can become quite efficient. By day two we were easily seeing 500 people with 3 docs and 3 nurses working together.
Moshi is a modest size town with a sprawling population of about 600,000. It is the nearest city centre from where we live and the KCMC is the hospital where Kilema hospital refers to for more complicated medical problems. I went there after the first caravan with a friend who asked me to give a ‘second’ opinion regarding a friend of hers who was ill. It is a large yet primitive looking set of buildings. The medicine ward was crowded and there were beds throughout the hallways and even in the landing at the top of the stairs. The hospital can provide most general surgeries but has a limited ICU. There is a large HIV research component that is carried out in collaboration with Duke University. It has pediatrics and maternal fetal medicine. Anything beyond that must go to Dar es Salaam. All non-invasive modern procedures (cardiac caths, laparoscopy etc) must be done through referral to India or South Africa. Occasionally patients seek care in Nairobi, 8 hours drive away. All of this next level of care is expensive and not paid for by the government…hence most of the citizens of Tanzania cannot afford it or go bankrupt trying.
Our stops this week were all so different from the first caravan as they were all located close to more populated areas. We had two busy days at dispensaries near the village of Marangu (where the most popular entrance to Kilimanjaro National Park is located). We had two full days in Himo Town, the hub I mentioned previously for trucks and travelers (and a lot more HIV/AIDS patients) and, we had two days at Kilema Hospital itself. At Kilema we ran our clinic outside under an open air area where the doctors often hold their morning ‘report’ and teaching sessions…quite a nice airy place to be compared to the two days in the ‘sweat lodge’ in Himo. The Himo clinics were held in a stone shed with a metal corrugated roof. The shed was used by the Catholic diocese to hold community meetings and other church related activities.
The cases this week were varied and interesting. There was always a sense of cross-referral and sharing of info as we worked side by side. I was most comfortable with sick old people and basic tropical medicine stuff but I would often ask Dr. Don Kilby about some of the baby related cases or difficult/unusual looking rashes. There is a ton of other sexually transmitted disease beyond HIV. Most women of child bearing age have some type of PID (pelvic inflammatory disease). We also try to treat their partners whether they are present at the clinic or not. It is hard to know if that strategy works at all or if they get re-infected within the next few weeks. I saw only a small amount of real bread and butter ‘medicine’ related cases that I was accustomed to, such as heart failure or angina. I certainly was not thinking a lot about nephrology. There is some obesity closer to the larger cities but most of these patients were grossly underweight and extremely fit from long days of hard work on their shambas. I don’t like to admit it, but, I did enjoy the variety. There were of course lots of ‘pain in the body’ consults that were mostly middle to older age women whose bodies had just had enough. Dr. Kilby was quite innovative on this caravan as he recruited a lovely and hysterically funny man named Patrick who was our resident chiropractor. Although patients got only about 5 minutes with him, I could see him working miracles on some painful shoulders and lumbar spines. He taught patients some exercises and provided a lot of comic relief. The patients really loved it and I think they thought he was doing some type of witch craft…this was like nothing they had ever seen or had done to them (see picture). Patrick always had an audience of women and men sitting on the bench watching him crack and manipulate the bones of some withered looking bodies. Many of the patients laughed out of nervousness, I think, but a lot of smiling went on in his ‘corner’. Most people here (mostly Chagga tribe) have a limited knowledge of the human body and there are some really interesting beliefs about how the body works etc. I had some little old ladies tell my translator that they started with pain in their right foot and then it travels to their right hip and shoulder and ultimately their right ear or eye…and then maybe over to the left!
I spent a fair bit of time reassuring healthy older people that they were not really sick, just old and tired from working too hard.
I have attached a picture of a child who we sent for testing who was supposed to be 12. The other pictures are of Patrick at work and one of me holding possibly the cutest baby I have seen yet (other than my own of course!). I also put one of Roman at work with Tom Kaul. I wish I could be more descriptive but the number of patients we see each day makes it a little overwhelming to try to describe the really interesting stuff.