Africans, Mikumi Mammals, and Morphine

So the car broke down on the way to the African Safari.  It could’ve been bad, but it wasn’t, and by that point I was so in awe of what I’d seen thus far that I felt like any situation would be a good one.  From Dar Es Salaam to the Mikumi National Park, we passed through many “towns.”  Back home these would be considered either gigantic expanses of homelessness or places where some sort of disaster relief from the government would be expected.  These are the “towns” where our patients arrive from and it really put our families in perspective to see these places.  All the hardship and chaos of these places aside, Africans by and large are very positively social people.  EVERYONE is outside all of the time, rain or shine.  I can’t even really tell what everyone is doing but they’re all out there and they’re all socializing.  Truth be told, each one of these towns looks like a big, disheveled party (kind of like some hot summertime music festivals I’ve been to) and everyone’s having a good time despite what it looks like from my perspective.  On the way through these parties, I bought some fresh cashews, had a coffee and some kind of meat pastry that was so good I got another one, and bought some hand-carved drink coasters made from ebony wood.  The Safari was everything Erica had to say about it and I agree that it was up there in the top 3 experiences I’ve ever had.  My favorite part, other than the hippoes, was when we became surrounded by a herd of Impala.  Hundreds of Impala and we turned the car off and just sat there while they hovered around us and then all sort of started to move at once.  Once they all started running it sounded like rain coming down.  Very peaceful.  Actually when these animals move in herds they’re kind of hard to see. They look like grass waving on a prairie or something like that.

Back to work today…more jaw-dropping cases and experiences.  I taught the team why people simultaneously lose fecal continence and have urinary retention with compressive spinal cord lesions….Some faint puff of smoke in my mind from med school years that came out very unexpectedly.  Fortunately some kids that were really sick last week looked a lot better when I walked in today…Smaller rhabdos and such.  Good to know they’ll need one less scoop from the common-use morphine jug!  Seriously though, there’s a common-use morphine jug that just sits on the desk for parents to come fill up when they need to.  Its the only pain med available here.

Til next time!

S

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Day 1

First day of official rounds/work today…A couple factoids about this place to get a feel for it.

There’s 1 ventilator…in ALL of Tanzania.

Theres no microbiology…no blood cultures.  Yes you read that right

Sometimes there’s just no water….in the whole hospital.

Theres 500 pediatric cancer diagnoses per year here, at least, with zero, zero pediatric oncologists.  For perspective on that for people who aren’t in our field, a robust program in the US sees about 150 new diagnoses per year, with about 8 trained oncologists on staff, and countless support staff.

These kids are tough kids.  They are really, really, really sick.  They have tumors eroding out of limbs and facial structures.  They have belly masses so big that they tip over when they try to stand up.  They have leukemia that’s invaded their eyes and blinded them.  It’s at least 80 degrees in the ward.  And still they smile at me and their parents are lovely.  Its pretty awesome to see.  The rounding team consists of multiple residents, a few general pediatricians, and two Muslim female interns who I accidentally tried to shake hands with (not kosher).  And there’s Sue and I.  I think I’m going to be giving some lectures to the pediatric residents over the time here; there’s 12-15 pediatric residents here at Muhimbili.

We had fried Tilapia fresh out of Lake Victoria for lunch today. Bony, but pretty good.

Erica has been a rockstar with the nurses.  But I’ll let her comment on that part.  Hope all is well back home!

Arrival and First Day….

Jambo!

My first Swahili word..I thought I had learned some great conversational words from this SWahili book at the apt and then when we went to the shopping market, I choked!  Couldn’t remember a damn thing.  Still, I’m determined to learn this fascinating language while we’re here.

The flght with Erica was a blast…She made me play HOURS of trivia which was great.  Like five hours of trivia.  We’re sitting here trying to tell you a factoid we learned during those five hours and literally can’t remember a single question.  Suffice it to say the flight was long, but fun and we got here in good shape.

First day was really cool.  I had pile of goat meat for lunch with some Tanzanian sauce on it (called Mbuzu), which was delicious.  I’ve also tried several of the local lagers, the best of which in my opinion is Kilimanjaro Lager.  Cold, crisp, clean, and very effervescent.  Great for the weather here although I have to admit it doesn’t hold a candle to Occidental Kolsch from good ole P-town.  Erica had some veggie currie which was delicious as well.  Oh and a Kilimanjaro Lager as well 🙂

Then after lunch and some wandering I came home to find a little kiddo named Dick who wanted to “teach me football.”  I agreed and two other local boys came out and set up two “goals” with 4 rocks, about 30 feet apart from each other.  He guarded one goal, me the other.  And we just kicked the ball back and forth on his instruction for about ten minutes.  I was thinking that it was a bit boring and how was I ever going to score on this kid if I couldn’t leave the goal-box…Then he formally introduced me to his two friends that constructed the goals and one was placed on my team and the other on his.  We were now allowed to pass, once, to the team-mate, who had to attempt to score or kick back to me, at which time I was required to attempt to score with one kick.  At that point I realized he was building the game up in steps….He was literally “teaching” me how to play football (soccer).  For level 3, we were allowed to leave the goal-box very temporarily.  Now came the opportunity for some strategy.  I was getting coached by my teammate, who couldn’t have been more than 8, and we started kicking some tail.  Well, he started kicking some tail.  I mean this kid was GOOD.  Dodging in and out, coaching me along the way, we scored 5 goals in like 5 minutes and it was starting to get fun.

Then 2 other kids came out of the woodwork and were placed on the opposing team…Wait, 4 on 2?  I guess that’s level 4. Nevermind that, I was now allowed to leave the goal-box continually, and my little buddy whooped up on his friends like he was the 36 year-old and I was the 8 year old!  We were now in a full on game and it was AWESOME.  a ridiculous amount of fun and we were starting to get spectators !  Babies, adults, toddlers, etc.  Then an adult french ex-pat and his little son, who was probably 5, entered the game after we were formally introduced by DIck.  Now 5 on 3, we were playing some hardcore soccer (with 8 year-olds).  I should mention that this was on pavement and the kids were barefoot, crashing into each-other, sliding all over the pavement, and having the time of their lives.

Once we hit ten goals, I started to get really thirsty (weird, huh?) and when I took a drink I realized I was REALLY thirsty.  I think I drank 3 liters of water during the game.  We were up 19 to 11 (playing to twenty), it was now 6 on 2 again with me and my little buddy against the world, and I crapped out.  I think I may have gotten a touch of rhabdo or hypernatremia or something, but I noticed that they were scoring a lot more goals on me despite my continued efforts at goalie.  They scored up to 19-19 in a fierce ten minutes of play.  All tied up, the youngest kid dribbled up, put a shot on me, and through it went.  They won, 20-19, and my little buddy was devastated and confused as to why I was such a bad goalie (with a smile on his face, of course).

I may or may not have let that last goal go through.  The kid that made the shot was tripped by me earlier in the game (by accident, as I said it was intense) and slid over the pavement.  I had also pegged his little brother with a goal-kick right in the chest (again accidentally, but I may have gotten a little bit too into it!).  So needless to say I owed the kid one.  So that, and my worsening rhabdo, may have played a part in that final goal going in, but the world will never know for sure 🙂

The game of the century had ended, I learned how to play football, and Dick will be waiting for me this afternoon for Game 2.  Apparently this is a series!

Tanzania Eve

Okay, just finished some lab stuff and now I’m going to pick up some stuffed animals and gauze from Sue’s office to take to Tanzania with me.  Thanks to Peter for excusing me from lab for two weeks of non-vacation days in order to have this incredible experience.  This is my first blog attempt, ever.