Day 2

Hi all!

Well, I think I get the post tonight, so you get the wordy writer today!

More things I’ve learned on this trip….I think I have finally figured out the medical doctor training system here so I will share and then tell you who is on the team this time around.

Children start primary school at age 7 years here and go to primary school for 7 years, so they finish around age 14 year.

Children then go to secondary school and this goes on for 5-6 more years, to age 19-20 years

Then they go to medical school which is 5 years, so we are to age 25 years.

Then they are an intern for 1 year and it seems like they rotate around whatever hospital they are at as an intern.  At Muhimbili it seems like they are only in one place for 1 maybe 2 weeks at a time.

Then it all becomes a bit free form.  You can choose to be registrar which is sort of an employed doctor for any period of time you want before you try to get a residency.  People don’t necessarily do registrar in the specialty they want to go into.  They may choose to be a registrar because of personal reasons such as wanting to have a baby or it may be out of necessity, because they need to be sponsored in order to become a resident (ie have someone to pay for them).

So when you decide to become a resident then residency is another period of time, for pediatrics it’s 3 years.

So there you have it, but it seems you can also pretty much never decide to go back to residency and still practice.

That all being said the doctor team is a lot of very familiar faces:

Dr. Shakilu and Dr. Laiti are the Master’s students

Dr. Living, Regina, Mwanaidi, Lulu are the faculty pediatricians

Dr. Edith is a faculty pediatrician but also has oncology training in adults and children in China-not entirely sure what that was exactly, a fellowship?

Dr. Beatrice, Aika are registrars.  Beatrice wants to do adult cardiology and Aika pediatrics.

Dr. Imran is the pediatric resident

There are 2 interns and scattered medical students.

Whew! I think that’s everyone.  Most faces are folks I know from the past which is great because that means some good continuity in the program.  Many of the nurses are the same too.

Then there are some exciting things on the ward:

The Upendo ward has been painted and it’s amazing!  Mr. Chongo, a local artisan, painted the whole thing and it puts our ward to shame!  It’s covered in an art called Tinga Tinga art and it’s all sort of animals and color and beauty!  I told someone we needed to bring Mr Chonga back with us and they astutely said we should take pictures and project them, sort of like paint by number.  It’s a good thought.

Another exciting thing is they have a water filter installed on the ward.  This was more exciting when we thought it worked more consistently, but when there is no water in the hospital to filter there is no filtered water.  Well, it’s still a significant improvement.

New outpatient infusion unit where the very unsafe outdoor patio was.  A donor gave money and they decided to enclose an outdoor patio area to become an outpatient infusion room.  The outdoor patio is off the waiting room and was always a great idea for the children to get fresh air but they were never able to get the wall high enough to feel safe so this is much better.  They are just putting the finishing touches on it and it will be open for business.

A chemo hood!  The nurses currently draw up chemo in the basement with no hood and Dee was able to get a used hood and new refrigerator.  So the plan is to renovate several rooms in the old Tumaini ward and one of those will become the chemo prep room.  The hood is in the room but not hooked up yet.  They need to get more plumbing, electricity, work tables and air conditioning in there so many fundis are being sought.  Fundi is a word for worker and you can be a fundi for just about anything.

That is all the new and exciting I think but that is some amazing stuff.

Rounds are going well.  The census on Upendo is a moving target but somewhere between 30 and 40.  I’m not sure about Tumaini because they keep saying not many are over there but some seem to transfer in and out of there each day.  The improvement in knowledge among the doctors is evident.  Things that were still getting missed last year are not getting missed this year.  That is great.  I think the continuity of doctors has a lot to do with it.

The children continue to be really sick and the extent of disease they have at presentation continues to amaze.  Their resilience also continues to amaze me.  I will tell you one story–warning, somewhat graphic  content for you non-medical types out there.  Skip to the next paragraph if you have a queasy stomach.  Lovely little 3 yo girl, Joycee, who has a rhabdomyosarcoma of the face with tumor protruding out of her eye and into her mouth disfiguring her left side of the face.  She just started chemo.  She has a trach because her airway is compromised because of tumor.  It is also hard for her to swallow anything solid because of the tumor.  But she is determined to eat–or try.  Yesterday in the morning she was eating porridge and she would take a bite, chew it up and spit it out.  In the afternoon she was having a great time eating watermelon where she would take a bite, chew to get the juice out and then spit the pulp back.  This morning the nurses called us over at the start of rounds because Joycee was bleeding from her nose, mouth and trach and coughing and coughing and her daddy was patiently wiping it away.  Can’t get platelets so a little transexamic acid and the bleeding stopped.  This afternoon she had  a cup of milk on her bed to drink but she was hugging a 1.5 L water bottle full of milk and giving her daddy an earful about how she needed all of that milk to drink because she was hungry.  And the lecture continued for quite some time.  And her daddy is so patient and was just chuckling at her with us.  If that isn’t resilience I don’t know what is!

I’m really excited about how things are going with the nurses too.  They are relating to Erica as a nurse in ways they would not to someone else.  She has already started formal teaching in addition to working with them and they are asking for more topics!  I think this could be the start of a great opportunity for a nursing teaching collaboration.

The internet is uploading slowly and I keep getting ahead so not much more but a few other fun things…

Shelton ventured out to the Serena Hotel today to change money and scored a back gate taxi driver named Mr Brighton who we have enlisted to bring  us home each day.  He used to work in the prison system for  35 years so when the  police pulled him over for no good reason he whipped out his prison police papers and away we went.

Game 2 of the football series Team Dick vs Team Shelton took place this evening.  AND with another  massive come from behind victory Team Dick takes a second victory!  Dick is a master of strategy and always seems to start with the “weaker” team and bring in the ringers once he is behind.  Tonight it was Dick and Erica vs Shelton and 2 other boys from Game 1, then once  down he  got a massively talented older  teen to join and it was all over.  Shelton even  tried playing  without shoes which  Hilda thought was hilarious.  Dick has assigned me to cheer from our 3rd floor balcony–I think he wants the stadium feel.

Ok, gotta stop, internet bad..



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