Return to Tanzania - 2011

Establishing A Routine - Such As It Is

We’re kind of into a routine now. Grace and Robert went off to make morning medical rounds which, frankly, I’d prefer to pass. I’ll see my  postops later and then have a surgical clinic to find cases for the rest of the week. We’ll all catch up for afternoon rounds. By then some surgical catastrophe will show itself as it did yesterday when a young man in a back ward was brought to my attention. Seems he has been in and out of there for ten days being treated for a urinary tract infection. What he had was a ruptured appendix that had walled off and formed a pelvic abscess. When it broke and leaked all over the inside of his abdomen someone figured it was time to call a surgeon. What a mess! He should do OK though. I’m surprised Jasper didn’t pick this up earlier.

Speaking of Jasper – he’s off to Dar for a seminar. Why not, he’s got free coverage. To act as my translator and general fixer he left  Coleman who is a physician and sort of Jack of all trades. His English is marginal but we get by. Coleman is one of the strangest looking people I’ve ever met. For those old enough to remember the name Godfrey Cambridge comes to mind when you meet him. (see photo) He’s really quite helpful but can be awfully clumsy in the OR. He had to take over for Grace yesterday when she was overcome by the heat. (we were in the old OR with no AC). The heavy cloth gowns and rubber aprons add to the discomfort. The surgery then became about doing the procedure with one hand while holding Coleman out of the way with the other. It turned out OK though.

We had a very strange dinner the other night with the Regional Commissioner. but I’ll save that for another post as there will be more to the story.

OK, off to clinic now. 

Getting Settled

It’s been an interesting couple of days. I finally managed a room at the Forest Way but now that I’m here I realize that you have to be careful what you wish for. There is a strange attitude at this hotel that I can’t explain. What use to be charming place that felt welcoming has turned cold and perfunctory.  I think I know why and the bottom line is I may move back to the other place which was perfectly adequate. We’ll see.

We initiated the new operating suite yesterday. Not intending to operate until Monday we came across a woman with an acute abdomen that had been neglected for several days and despite it being a weekend I pulled the trigger. The crew was slow getting things together – it took six hours to actually get started but we got it done. Grace proved to be a remarkably good assistant.

The hospital seems to be suffering from the same problems as past years. The personnel situation seems a little better but the lack of simple supplies such as catheters, tubes, urinary drainage bags bandage materials, etc. is worse than ever. This was driven home this morning when we went to see our patient from yesterday and found her lying in a bed soaked with urine. I was told this was because a collection bag was not available. I told them to do the obvious – clamp the catheter off and open it every few hours to drain into a pan until I can buy a bag at the local medical supply store. How frustrating it is that theses supplies are available across the street but are not in the hospital because the supply chain emanates from Dar es Salaam 700 miles and several layers of corruption away. Oh well, it is what it is and my job is to function within the system and do the best I can. I will, however make waves. We went yesterday to pay our respects to the Regional Commissioner (Governor), who is a friend from past trips and sign the book. He invited us for dinner tonight at a new restaurant. Hopefully we can get down to talking about some issues surrounding the health care system. If there are too many people there I will arrange to meet him privately.

Tomorrow (Monday) will be the first full day at the hospital. If you get to read this I have overcome a problem. The local internet café will not allow flash drives and I don’t have time to sit there and write all this during the day. I have a G3 device but it is so slow that uploading is impossible. So the plan is for Grace to create a diversion while I quickly insert the thumb drive and move these files on to the desktop.

Stand by.

PS: I found a computer on which I can use a flash drive. Now I'll be able to include pictures. YES!!!

We Have Arrived

 

Starting out on a long journey to a remote place for the first time is a daunting experience fraught with uncertainty and fear of the unknown. By the fourth time one knows pretty much what to expect. The special places and people one is glad to re-connect with continue to make it fun but an uneventful trip can be way too long. The best part of this trek was getting to see it through the eyes of someone experiencing it for the first time.

Dr. Grace Stewart is a colleague of mine from ATSU, the medical school where I teach. We have been good friends for years and she has often heard me speak of my Africa experience. When she expressed interest in joining this mission I was delighted as she is a wonderful teacher and adds experience that I don’t have in internal medicine. We started out in Phoenix on Saturday and arrived in Sumbawanga this evening, Thursday. Even with ten hours lost in time zones that’s almost a four day trip that was uneventful except for one incident. Followers of this blog will remember that I have more than once described the snake pit that is the Mbeya bus station. It was dark when we arrived at that open air chaos and we were surrounded by a group of men who seized our luggage and insisted on hauling it to a waiting taxi. I certainly intended to tip them until they surrounded us angrily demanding an outrageous amount of money. The situation was turning ugly and the driver suggested we get out of there. Using his size and my best Clint Eastwood snarl we stared them down, got in the car and drove off.  In all the time spent in Tanzania this was the first time I’ve ever had a confrontation. One other glitch is that only one room was ready for us at Forest Way so I’m staying a day or two at another place down the road that is somewhat more Spartan but still comfortable.

Tomorrow we’ll go to the hospital bright and early to make the formal introductory rounds of the local officials where I’ll introduce Grace. She outranks me academically and, in this culture, that may be hard for them to get their minds around. Then we go to work. I’m told  the new “operating theater” is ready so here we go.

Here We Go Again!

It's hard to believe that a whole year has passed. The person who first observed that years pass more quickly as we get older found few believers among the young who see it as struggling through thick molasses. They will hardly notice the substrate of time thinning out until they, too, find themselves swept along in a tide that eventually begins to feel like WD-40. Oh well, I guess that is the price of experience.

I'm headed back to Sumbawanga on the 20th for what, I believe, will be the last time. My purpose is twofold. First I want to do what I can to make sure that the beautiful new surgical and obstetrical facilities have what they need in terms of systems and supplies. I know I'll be able to operate more this year because the logistics will be so much better. Second, I need to get some questions answered that have been bothering me for a while. I want to get a strong handle on the degree of commitment that exists on the part of the officials who are charged with running the system.  My conversations with these people over the years have been polite and correct but I feel I know them well enough now to to ask the hard questions. They may or may not answer truthfully but there is always a wealth of body language and continuity of logic that say so much.
I'm joined on the trip by several people converging from the UK and around the US. We have RN's, dentists. medical students and my own colleague, Grace Stewart, who is a first class primary care physician as well as a great teacher. She will be quite an asset. Unlike short mission trips that are often organized like military operations, these month long forays develop day by day and there is really no way to predict exactly what might happen. If you have some time go back into the archives of this blog and you will see what I mean.That's it for now. My next post will be from Sumbawanga, Tanzania on the 24th unless something really out of the ordinary happens on the journey. The trip is Phoenix, New York, Dubai, Dar es Salaam by air and then 2 days overland to Sumbawanga.

Until then...................