Wednesday, July 4, 2018
|Lunch staple, fish with rice, beans and Mchicha (like spinace/turnip greens)|
|Team at lunch|
|Restaurant where we've been eating lunch every day|
|Food has arrived!|
|More staples--chips mayai (eggs), miskaki (skewers) and more rice.|
|Washing hands before and after eating|
|Dr. John, Christina (Mazimbu anesthesiologist) and David with new cautery machine donated by team.|
|Stylin' in my Foster Grants!|
|I can see!|
We are thinking of our families and friends this Independence Day, imagining what you are all doing to celebrate this holiday.
It is Wednesday morning in Tanzania and we have begun a very busy day.
Our last post was an update on our weekend. Since then the work at Mazimbu has continued and we do not leave the hospital until 6 or 7 pm each night. We have reached the point in our schedule where we are completely full, so we are not accepting any new patients. Dr. John has five procedures scheduled for today and will be seeing about seven new patients that will wait all day until he has some time between each procedure.
Although the purpose of our mission is surgery, we find that each year God brings an acute case to us that is unrelated to surgery. This year there have been two. Kulwa is an eight-year-old Maasai boy that we first saw laying listlessly on the bench next to his mother, who was waiting in queue to register her baby daughter to see Dr. John. Emily came to check his vital signs and his temperature was recorded at 105.7. There were many other indications that Kulwa was a very sick little boy. Unfortunately, it was after 5 pm and the Mazimbu doctors had left for the evening. After consulting with Dr. John, we advised his mother that he needed critical care through the night and to take him to the Regional hospital. When we arrived the next day, we were surprised to see Kulwa again, but this time he was walking around and smiling, clearly improved after treatment. The team gave him special attention every time we passed him by during the day, hoping to catch his infectious smile. By the end of the day, Kulwa felt happy to be around any of the team and would greet us willingly. The following day was a different story. Kulwa was sick again so one of the Mazimbu doctors took over his care and admitted him to the hospital. Dr Richard determinted that Kulwa is HIV+, has acute Malaria and probably a cardiac problem and possibly pneumonia. IV antibiotics were given and Kulwa was discharged yesterday. But, again, we had our friendly, sociable Kulwa greeting us all day yesterday.
Our second case came to us on Monday. Happy James and her husband Manfred registered in the queue for services. As the day wore on, Happy became increasingly weak and needed the assistance of a wheelchair. She was treated by the Mazimbu staff and seemed somewhat improved by the end of the day. Happy and Manfred were told to return on Tuesday but when they arrived, Happy was even sicker and was unable to walk. Dr. Richard admitted her, and the team has accepted financial responsibility for Happy. She was given a unit of blood yesterday and may need another unit today. The team stands ready to donate if we can help. We have checked on Happy this morning and she is now sitting up in bed and smiling.
After today, our work will be almost complete. We are not at Mazimbu tomorrow, but are journeying to Berega to meet with Tisho and learn about the orphanage where he is the director. So, Friday will be our day for cleanup, packing and farewells.
We haven’t mentioned this yet, but this year we added a few new things—we brought MANY reading glasses of different strengths and Eileen and Debbie have been having fun with patients, teaching them how to use a reading chart to determine the best strength. There have also been some sunglasses to pass out. And Dr. John found an app for doing hearing tests (yes, there IS an app for that!) and Pati and Epsilon have been giving hearing tests. This is trickier than you might think because it requires a very quiet environment, which is very hard to find at Mazimbu!
Sunday, July 1, 2018
Friday was a day of challenges for the team. When our daladala pulled into the Mazimbu lot, our queue completely filled our “check in” area and spilled out and around the corner. Dr. John had nine patients right off the get-go—people that either had waited all day a prior day or a few that we checked in late in the day and told them to be back early on Friday. That meant that we could add only about five more patients to his queue for the day. So the decision was made to check in only 35 new patients in the hope that Dr. Kivuma could see about 30 that day. However, Dr. Kivuma had four procedures, so he would be away from his office for big chunks of time. That meant we had very bad news for about 170 people. Episilon and Samwel were calm and kind but worked with a very agitated crowd for almost two hours. It was impossible to determine who had arrived first and would be served that day. Finally, the security guards stepped forward and were able to identify those that were there first. Once the selection of the 35 lucky ones was made, the crowd accepted the decision and melted away.
|Dr. John in OR|
|Using the gurney to move the patient to recovery|
Emily continued working on our suture shortage and Nancy joined in the hunt. They got the OK from the anesthesiologist, Christina, to go through every box of suture in the OR. By doing that, they discovered a box of mixed sutures—probably the last piece from different boxes that was just tossed into the mixed box. Most of them were also expired but this process yielded two pieces that were usable. That made a total of three pieces, so the first two procedures were scheduled for that afternoon. A call to the dermatologist at the sister hospital, SUA, also yielded the “loan” of four sutures. And finally, Emily’s connection at Aga Khan bore fruit: she was able to talk to the clinical instructor that worked under her at Aga Khan, who met with the main hospital supplier, who agreed to order some sutures, who saved them when they arrived, who gave them to Gamma’s best friend, who took them to the bus station and put them on a bus to Morogoro to get them to Gamma, who drove to the bus station to meet them and pick them up. We now have enough suture to perform the procedures!
We did not leave the hospital until about 7pm Friday night and went directly to Dragonaire’s restaurant for pizza. Although we really enjoyed the fellowship with the team, the staff was busy that night so service for our party of 18 was slow. It was midnight before we fell into bed and off to sleep.
Saturday is a day off for the team and we all opted to take the trip to the local Maasai cattle market. We were joined by Amanda, a student from Vermont that is studying at the language school. Samwel and Epsilon rounded out our group. Samwel is a Maasai from the same village as Tisho, Melela, and was an excellent guide, answering all questions about Maasai culture and practices and offering interesting items we didn’t know to ask about. After walking and shopping for a bit, we joined Bishop Mameo under one of the bandas for food and drink. This is really a treat at the cattle market—cows and goats are slaughtered and butchered in the morning and slabs of meat are set to roast over open fires. Bishop ordered both beef and goat. This is sliced into bite sized pieces with a machete by a Maasai warrior and passed around, where portions are dabbed in a bit of salt and eaten with the fingers, hot and flavorful.
We were also honored to sit with and be introduced to the Chief of all the Maasai, Chief Moreto. While we were sitting enjoying our food, many many Maasai strolled through to give the Bishop and the Chief their greetings.
|Maasai cattle market|
|Eileen and Maasai admirer|
|Driving cattle to market|
|Under the banda|
Mid afternoon found us back at LJS for a brief rest before we went to one of our favorite restaurants for dinner—the Oasis. The specialty here is sizzling platters served with vegetables and sauce and the meat of your choice. It was a great meal and we would all vote to return!
Our weekend would not be complete without worshipping with our Tanzanian brothers and sisters. Bishop Mameo specifically requested that we come to a celebration for the opening of a new pastor’s house. We did not know what to expect but we were treated to an amazing service. It began with tea and “bitings” of cassava and taro root before church. Then we were seated in seats of honor, being sure to ask Kilatu and Epsilon to intersperse among us to help with translation during the service. The sound of a brass band signaled the start of worship with a processional into the church that had toes tapping and hips swaying. Following the band were 18 pastors, the Bishop in full regalia, and the assistant to the Bishop. There were three choirs—the regular church choir, the youth choir and a special choir of university students. During the service, each choir sang at least twice. Although the three-and-a-half-hour service was much longer that we are accustomed to, it was a wonderful worship experience. We were given lunch, along with the whole congregation, and made our way back to LJS for a bit of a rest before dinner.
|Recessional with 18 pastors|
|Tea and bitings|
|Maasai woman and daughter with Dr. John|
|Our young friend|
Thursday, June 28, 2018
|Dr. John's consultation|
|Debbie's friend showing off his new shades|
|Stickers for the kids|
|Eileen in pharmacy with one of our repeat patients|
|Emily working triage with a young admirer|
|Lance and Matron Seguru. Lance said he takes all tasks in order--the last thing Matron gives on the list is the one they do!|
|Pati and Samwel|
|Nancy with Hezron reading her grandaughters' letters|
|The birthday girl, Andie, and her sister, Evie|
Our main story today is about the hunt for the correct sutures. Emily has continued to work with her contacts in Dar es Salaam while Gamma sought out the few dispensaries in Morogoro that were rumored to be possible sources. As of yet, we have totally exhausted all possibilities in Morogoro but we have had a glimmer of hope from Emily’s Dar contacts. We hope to have a final resolution tomorrow.
Dr. Kivuma was in the OR with four of our surgeries and unavailable for clinic most of the day. That meant that Dr. John would see the majority of the patients today. We registered 35 patients in the morning before making the decision that we were at capacity for the day. An additional 15 patients were “pre-registered” for tomorrow. But there were more than 50 hopeful patients that were told to come back the next day and to be sure to be early—our queue is first come first serve.
One of the benefits of working year after year in the same place is that we often have prior patients come back to visit and let us know how they are doing. We had two such visits today—Christian was a young man that received our services two years ago and he formed a friendship with Debbie. They have stayed in touch for the past two years, and we were all glad to see him and greet him in person today. And Nancy, who spreads her love wherever she goes, became attached to a young teen boy, Hezron, also two years ago. Hezron was a very sick young man who had been admitted to Mazimbu for treatment. Nancy ministered to him and visited many times each day, using the children’s bible app on her phone to cheer him up and break through his stoic attitude. He seemed happy to see Nancy and enjoyed receiving the small gifts she had brought from home. But the most touching moment was when Nancy showed him letters written to him by Nancy’s young granddaughters, ages 10 and 7. Hezron read them aloud and actually smiled at the conclusion!
The highlight of our day was the third birthday celebration of Gamma and Emily’s oldest daughter, Andie. We gathered in the common room and enjoyed the delight on her beautiful young face at the site of her cake. We all got a chuckle when Andie got distressed when her mom approached the gaily decorated cake with a knife—definitely too pretty to eat!
Wednesday, June 27, 2018
Tuesday saw our first day of work at Mazimbu begin with the usual fumbles and mis-steps as we relearned and updated our procedures. After several hours, the team was again firing on all four cylinders and ended the day with 35 patients on our registry. Before any surgical cases can be identified, we must first do clinic so that the doctors can evaluate our patient’s issues and take the appropriate treatment, which may mean only a simple RX, but could mean a surgery.
Dr. John’s specialty of ENT is somewhat more specialized than other practice areas so it is likely that only a dozen or fewer surgeries will fall under his area of expertise. He is still seeing all clinic cases, though, and will take “lumps and bumps” off of anywhere! Dr. Kivuma, a surgeon with Mazimbu, is again working as one of our team doctors. So Dr. Kivuma and Dr. John worked our clinic together and identified five patients who were then scheduled for a procedure for the following day, Wednesday—three for Dr. Kivuma and two for Dr. John.
Both surgeries that Dr. John scheduled require a thin, fine suture. The only sutures at Mazimbu that fit the bill expired in 2016. This makes them totally unusable, under government regulations. So the hunt was on for the appropriate sutures. A call to St. Harry’s, where the Tanzanian ENT practices, yielded some hope. Although they did not have any on hand that would work, they assured us that they would order them from Dar es Salaam and have them for us first thing the following morning. What a great solution!
It is sometimes a challenge to diplomatically manage the great numbers of people that come to the hospital hoping for services from the Mzungu doctors. Bear in mind yesterday was our first day, so word-of-mouth about our presence has only just begun. Although 35 patients were registered, another 50 patients were told that we were full for the day and to return the next day, Wednesday. Our senior translators, Epsilon and Tisho, were invaluable in skillfully communicating this to people who had likely been waiting all day, hoping for their chance with our doctors.
Today, Wednesday, most of those 50 were waiting for us when we arrived shortly after 8 am. And another 50 or so in addition. Again, our senior translators had the unpleasant task of telling the crowd that we had a waiting list and would not be able to add any additional names, but they could come again the next day.
Because of the issue with the sutures, Dr. Kivuma began his surgeries to give us more time to receive the delivery from Dar. Unfortunately, this delivery did not pan out, despite repeated calls to St. Harry’s. So both of Dr. John’s procedures were delayed for a future date. We have worked on the problem and think we may have a solution: Before Emily’s first daughter was born, she worked as an RN on the surgical floor at Aga Khan in Dar es Salaam so still has contacts in the medical world in Dar. She has reached out and once we find where we can buy the sutures in Dar, it will be possible to have them sent up on the bus in just one day. So we are hopeful that both procedures will be possible early next week. Stay tuned for more updates!