This week: Watoto (babies!)

This week I have been in the OBS and GYN ward at the hospital.

Heather and I began Tuesday by simply walking right in and offering the “sisters”, aka nurses, shortbread cookies.  It is also fair to say we walked in with ONLY the cookies, lacking any previous knowledge or experience in labor. We shuffled into the labor ward and noticed that five beds were occupied, and two of the beds were taken by screaming mothers. The women are not given any painkillers in order to hasten the second stage of labor.  We had no idea what we were doing, or what was going on… so we stood around until one of the nurses snapped on two pairs of sterile surgical gloves.

An injection of oxytocin was prepared and a sterile pack was set on the end of the bed of the birthing woman. I stood at the edge of the bed looking on as the nurse half guided the birth. She wore a very tired, apathetic face. My face was lit with excitement and anxiety. Before I knew it the head was out, and the rest of the body was guided out in a short instant following the head. I felt a rush of indescribable joy and happiness that moment. It was truly a feeling I have never felt before. My body suddenly warmed toe to head, and I heard myself utter an uncontrollable “aw.”

I saw that child take his very first breath of air on earth.

The following day in labor ward a crying baby was slow to come. After about one hour of waiting, the screaming from the mama of bed three began. A baby was born. The baby had low muscle tone and was having difficulty breathing. The births I had seen the day before lacked complications, so when this blue baby was born I was unsure how to stimulate breathing. We rubbed that back of the child vigorously, before the nurse brought him to the newborn warming table. The sister used suction until she entered a suction tube down the baby’s nose and throat. The machine broke, and the nurse reverted back to manual suction. Final the baby was breathing well enough that they ceased suction and let the child lay under the heat lamp. It was clear that the baby was still having trouble getting air in and out of it’s fresh lungs. It was painful to watch the fight of this 15 minute old mototo. All we could do is hope for a happy ending.

Upon walking back into the labor ward we found the doctor who was in distress over a woman who had umbilical cord prolapse. Umbilical cord prolapse is a delivery complication in which the umbilical cord leaves the body before the infant. Because the umbilical cord is the fetus’s lifeline, without it the fetus will die.

This woman had to be rushed into surgery for an emergency cesarean section.

I SCRUBBED IN!

Thankfully I had a second pair of scrubs, thanks to Zigi for running home to get us (Heather, Zigi, and I) an extra pair. What we didn’t have were hairnets, so we used old cotton rags pictured below. We looked pretty official.

If I thought I couldn’t handle blood before, NOW I without a doubt know that I am capable of seeing blood… and lots of it. We saw handfuls of blood in surgery. The mama was first given a vertical cut sternum to lower abdomen. The second small incision was in the fascia, which was made bigger by ripping a bigger hole to make the uterus visible. The last incision was made in the lower portion of the thick uterine wall. The doctor quickly grabbed the baby by the foot (the baby was positioned breach in the uterus) and set her down for the nurse to take over. The nurse whisked him away and we heard a faint but audible cry. We all smiled and awed, thankful that she was healthy. Before the three layers of suturing the doctor showed us the woman’s anatomy (briefly). Looking at the tightly packaged organs was my favorite part. He also showed us the very full bladder, which was the reason behind the initial vertical incision. Next was the bloody suturing… three layers of it.

The doctor did a beautiful job. After the Ketamine (street name: angel dust) had worn off the patient was dazed but awake and healthy.

Heather and I saw the baby in the neonatal ward today, pleased to see it’s happy smiling face.

Today (lao) is Thursday. Our move tonight will be to club ViaVia with many other volunteers and friends! It will be lonely without our crew of 12 but we are anxious for the night regardless!

Holiday

Happy Eid al-Fitr from Tanzania!

Eid is a “festival of breaking the fast,” celebrated by 1.6 billion Muslims around the world. It follows Eid al-Adha, which is the “festival of the Sacrifice.” The holiday’s significance comes from the commemoration of Ibrahim (Abraham)'s willingness to sacrifice his young first-born and only son in obedience of a command from God. Today the Islamic population celebrates the end of Ramadan fasting. Celebration includes family and friend gatherings, sweet dishes, using perfume, wearing new clothes, musically performances, etc.

The streets are often loud with backfiring motorcycles and loud rusty cars, but this morning I woke up to Islamic music bursting through my bedroom window; it was a nice change. I knew the holiday was upon us and the music excited me! I went on a run with Ben this morning hoping to see some of the celebration. The streets were much less crowded than we are used to. We noticed many men and women dressed their kufi’s (cap), and hijab’s (head scarf). We passed by a Mosque FULL of people. The ceremony was so loud that we could hear it from across the street. This volume was surely to accommodate the 100+ people outside the building listening in. The experience didn’t stop there. Heather and I decided to go into town to food shop, but before doing so we were invited into our neighbors apartment to have a special treat. We were caught off guard but very pleased to join. We sat on the couch and waited as our Islamic neighbor’s wife set out some sweet dishes for us to try. The first dish is known as, Seviyaan. It is boiled milk, sugar, and Vermicelli. I enjoyed it very much. This experience explains the festival's alternate title of “The Sugar Feast.”
Our neighbors were so kind to allow us to join them in their celebration, which continues into tomorrow. I am pleased to be learning about the many cultures and religions that surround me in Arusha!

Colorful land, colorful culture

Good morning everyone!

Another adventure to update you all on: a hike halfway up a dormant volcano to see a 50m waterfall.

Clemmons, our tour guide for the day, started us about 12km from our waterfall destination. The scenes weren’t like anything I have ever seen before. I will attempt to describe them but there is no way I can describe the beautiful landscape, no matter what mix of adjectives I use. If I were to paint a panorama of what I saw yesterday, I would only need four colors: green, brown, black, and white. Everything I touched with my feet or my hands was either earthy brown or various shades of green. But, upon a close-up view, I would add every other shade of the rainbow due to the wild flowers that were sprinkled perfectly across the land.

 I couldn’t help but pick one and put it behind my ear.

The land we walked wasn’t a compilation of random backyards it was village farmland. Each way you looked you’d see patchwork of various gardens.  What kind of fresh food vegetation did we see? Maize, carrots, beans, red cabbage, Chinese cabbage, avocado trees, sweet potatoes, brown potatoes, zucchini, COUNTLESS banana trees, and my favorite of all… coffee bean bushes. Did you know that coffee beans are sweet before being dried and roasted?

We also pick our own FRESH carrots…

 I don’t know what heaven is like… but I imagine it’s similar to this magical place.

 According to Clemmons we passed through three villages on the way up, one of them being his own. His village is the Kipande village, which translates into, “a piece of something.”

We were told this while we sipped banana beer provided by his friend since childhood who brewed the batch fresh that morning before we all journeyed on our hike. It was an interesting flavor, very acidic but sweet with bananas. 

The taste didn’t matter because, according to Clemmons, banana beer is a drink that brings people together. It is only served from one shared cup. The people who share it are usually strangers who leave with a tummy full of ndizi beer, and a new group of friends.

After 4 liters of banana beer gone, we taught our new friends the game of Frisbee. We played with a bucket lid that some young children (mtotos) were playing with. Our game consisted of 13 people, and our goal was to get 10 caught passes in a row. We had so many good laughs at falls, and fails before we finally reached our goal. We carried on down the mountain through a number of villages, passing more farming land as the sun set at our backs.

I fell in love with the countryside yesterday. I once thought I was strictly a city girl until I imagined my life in a small hut made from banana tree stalk, running through the hills each morning before tending to my our fruit and veggie gardens.

This morning I woke up at 6:50a for church. I thought it was going to be impossible to wake up, but I was reminded at 6:30a that our complex has a roaming rooster. I was up and ready for mass at seven-thirty. Phabian came to pick me up with Harriet and we were off to church. I was eager to compare the differences between a mass in the states vs. Arusha.

For starters, I soon realized I was the only white person of nearly 300 local Tanzanian people. As mass went on I realized that coming in late to church is no problem. Rather than seeing a your average five late families, the church began with the amount shown in the picture below, and grew about four times that amount.

Of course, this attitude is something readily accepted here. “Pole, pole,” which is Swahili for “slowly, slowly” is the motto here in TZ. I read in the same tour book mentioned in a previous post that arriving 30 minutes late to an appointment is on time, and arriving an hour late is acceptable. Those who know me well know that this place is absolutely perfect for me and my bad habit of being late. Oh and the choir singing was magical. We clapped during the songs, and there was no book to follow, the people in the pews knew the words and sang along with ease. I wanted to dance along with the musical artists! Their enthusiasm during each song persuaded me to ask Phabian if we could sit next to them next Sunday.

The Swahili mass lasted two hours, which is double the time of mass at home. Because I couldn’t understand the words I decided to say a few rosarys on my new 2000 TZ Shillings ($1.30) rosary. The most interesting difference to me was that all those volunteering to give money during the offering and/or participating in communion just got in line when they felt like it (no one was ushered to leave the pew during these events). Although, this felt like disorder to me, all things continued without a problem. I had no clue when to stand up to receive the bread…

Apart from the differences, many things were the same. The progression of the mass was the same. I knew when the sermon was being given. I kind of knew when to stand, sit, and kneel (thanks to watching others, of course). I murmured the Our Father prayer under my breath in English when I knew it was being recited. AND my VERY FAVORITE part of mass was offering peace to those in the pews around me. To those of you reading this who are not Catholic, that is when we offer those around us a sign of peace: handshake, hug, kiss. In TZ this moment was so special to me. Church was a bit cold this morning but this instant warmed me right from my heart out.

amani na awe nanyi – Peace be with you

xo

miss you guys.

Thoughts Tonight

Tonight I lie in my bed wide awake thinking about my time in Arusha since I arrived 11 days 6 hours and 30 minutes ago. I am trying to put into words how I'm feeling right now.
It's a mixture of love, sympathy, frustration, excitement, gratitude, pain, and happiness. All the negative adjectives can be explained by both what I've seen at the hospital and the surrounding cultural environment. 
I finished another night shift at the hospital tonight. We all had a productive night of learning and growing, as we always do.
I felt love today when I held a little boys hand as he received a 5% dextrose IV drip. The little guy was suffering a hypoglycemic coma. He had been rushed into the hospital by his mother who feared she was going to see her son die.
I felt sympathy for the mother who wouldn't even let go of the 7 year olds hand, not even to grab her phone to answer relative's calls or get a drink.
I was frustrated when I was told a patient from gen med wasn't going to get the medications she needed simply because the family refused to get them. Especially because those same family members treated other med students and I terribly upon the young girls arrival into the ER Wednesday, stating the urgent need of attention to her situation. 
I am excited to embark on a 15 mile hike around Mt. Meru tomorrow.
I am extremely grateful… for countless reasons. I am grateful for the small: being able to sleep on a mattress. I am grateful for the big: the chance to be here in Africa exploring a new culture each day.
It pains me to have to see the economic snuggles of a a 500 bed regional hospital... because I know if they had more money and more equipment that could serve the sick better.
I am happy. Happy to be breathing, living, and smiling.
Goodnight world.
Xo

Loving and Learning

“Nafurahi kukuona” is my phase of the week. I have been slacking on new lingo outside of the hospital. HOWEVER, I have been using the following words in the hospital: pain, where, good job, so sorry, why did you come to the hospital, blood, yes (in response to being called), head, and stomach.

But, my phase this week comes from an encounter I had with an Army man from the Congo. I met him in radiology as he assisted a patient there. I was waiting with Heather, Sophie, and the Elective Africa's assistant coordinator, Phabian, when he approached us. I spoke the little Swahili I knew and introduced myself, and the others did the same. He explained his background in choppy English and we had Phabian translate what we couldn’t communicate in Swahili about our background. We all ran into the problem of not being able to say, “nice to meet you.” He taught us how to say it, and we had a good laugh as we struggled to pronouce it correctly.

He was really good looking… I should add.
After speaking to the head doctor of the radiology department and as we were leaving the ward I ran into the Army man, Nukuna, once more. He grabbed my hand, and as I said bye (kwaheri), he said “I love you.” I asked him to repeat it and he repeated the three words often heard after 7 months of dating not within 7 minutes of meeting. We had a laugh.
Watch out mom, I may come home a married woman.

I want to quickly mention today’s events at Mt. Meru Regional Hospital. We again went on rounds with Dr. Farrah. He encourages us to complete the rounds independently as a team. We are even encouraged to make an educated guess on the diagnosis based on patient history, current symptoms and a physical examination. Today we had five volunteers from Elective Africa, and one from Work the World. We saw everything from chronic renal failure, to gangrene. We ended the shift with a plural tap/pluralcentesis…. AND I ASSISTED. Only with the lung-fluid draining process but I assisted none the less!

Check out that photo bomb ;) 

Tonight is a big night for us in the program. It is one of the last nights we will all be together as 12 (including Phabian). After a great week at the hospital, we are all eager to have a few drinks and relax. I’m lucky to be here in Arusha with such an fun group of people. XO

Today:

Completed rounds with Dr. Farrah in General Medicine Ward

            -Walked through SOAP (Subjective, Objective, Assessment, Plan)

            -Performed OBS (Observations/vitals)

Gave my first IM (intramuscular) injection – 100ml Tramadol

Saw my first amputation (tip of the finger to DIP joint-Distal Interphalangeal joint)

FUN FACT: did you know that in our bodies we have a ratio of 10:1, bacteria to cells? It is true.

I am not gonna lie… the amputation had me feeling a bit faint. The boy must’ve been a mere 12 years of age. He was such a champ, only wincing when the med student or Dr. Mlambo hit a spot that hadn’t been numbed by the Lidocaine.  

Going to join some others for night shift in causality tonight. Let’s hope for another busy night!

Types of patients I have dealt with in GenMed, or Cas: HIV, AIDS/ stage IV HIV (CD4 count under 200), Malaria, Brucellosis, Status Asmaticus (acute asthma that remains unresponsive to initial treatment of bronchodilators), Cryptococcal Meningitis, Diabetic Ketoacidosis (DKA), Mitral stenosis resulting from A Beta-haemolytic streptococcal infection (Strep—> Rheumatic fever), Atrial fibrillation, patients with external wounds (broken bones, gashes, burns, generalized abdominal pain).

Kwa nini uma kuji hospital?

Most of you who are reading this probably know me pretty well. You may not know, however, that high stress situations involving blood and guts don’t necessarily suit me.

Since the day I began this program, I was told the causality ward (better known in the U.S. as the Emergency Room) is where I would find the most hands on experience. I was unsure about this idea especially after hearing the horror stories from the others. It probably wouldn’t be as scary if the hospital we volunteered at had more money. In the ER, construction paper is used to wipe dirty hands, the scalpel doesn’t have a proper handle, there are no scissors and any metal tools are rusted. I know in my heart that despite the unfortunate conditions, we are all here to dedicate our time and knowledge to Mt. Meru Regional Hospital; and we did just that last night.

Five others and myself decided to work the causality night shift last night. We were picked up by our driver around eight (half an hour after we were meant to leave) and arrived at the hospital ready to work, with the doctor nowhere to be found. Two patients lie on the bed. Patient no. 1 had just been in an accident; patient no. 2 had not urinated in a full day. Patient no. 1 was carried out by his brother (caca) and sister (dada) after two hours of not being treated. We understood the family’s pain and frustration. We knew the English-Swahili language barrier did not allow us to respond to what he needed.

The language barrier makes it so difficult for us to carry out normal tasks at the hospital. When one is in pain and needs help in an instant, communication is everything. Think of all the things communication allows in the hospital: an explanation as to why the patient came to the hospital, a full history, a means to talk through treatment with the doctor/nurse, and a way to console the patient and family. But, as I said before, we do what we can, because that’s all we can do.

After the first two patients were cared for were gone, we all stood around waiting for the doctor. Nine o’clock passed like molasses. In that time we met the lead doctor on shift, Dr. Line (Lean-Ah), and some of the nurses.

Finally some action appeared with the introduction of a drunk patient who had just been in a motorbike accident. He needed three sutures above his left eye. He also had burns on his right arm and knee, and superficial cuts all around his head. Ben, who is a fifth year med student, talked me through a full body physical. Next, I watched Ben perform the suturing job on the man’s eye, providing comfort to the patient by holding his hand.  Let me mention the blood was GUSHING out of this mans deep cut. Heather had explained to me following her first night of causality, “After the first gruesome scene you see, they all begin to look the same.” I felt confident that I could stomach anything.

 I didn’t know what I had coming…

11:30p.

Ane and I were looking on as a mother talked to Dr. Line about her child’s symptoms of pneumonia. Suddenly, a woman ran in yelling, screaming and pointing to her chest. Five seconds later a man was wheeled in with a trail of blood behind him. The doctor looks to Ane and I and says, “bullet wounds.” I then watched as the man took off his first layer of clothes to show an underdress DRENCHED in bright red blood, neck to knee. I turned around for about five seconds, before I got a rush of adrenaline. I walked to the end of the bed where he lay in shock. The family is surrounding him; the surgeon joins the circle around him. The surgeon shows us the entry and exit of a bullet in the ankle, two more in the thorax, and one in the arm. Whoever shot this man wanted him dead.

Not even two minutes later two psychosis patients came in screaming and yelling. They we sedated with diazepam and taken on a stretcher to general med.

A minute after that a female victim of domestic violence came in. I was hovering over the doctors shoulder during this time and she turned to me and said in a whisper, “bite, her husband bit her.” She had a large gash above her left eye. I was told that I would see domestic violence while I was her in TZ. My heart broke as a looked at this woman’s sad, embarrassed face. Another perspective put into place for me… In America girl’s fuss when they don’t receive flowers “just because,” while in other parts of the world women fight for their lives in disputes that could end like this one.

At 12a our night ended reluctantly. We all talked about our busy night on the car ride home with enthusiasm.

Today I am heading to the general medicine ward with four others. This is the in-patient ward. Time to throw on my scrubs and get to Mt. Meru! xo