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Saturday, July 31, 2010

Patients or patience

Americans want productivity—give us numbers. Thursday was a slow day for the clinic, which gave the team more time to talk with the Tanzanian staff at the hospital. God may have been pushing us in the direction of solidifying our relationships, which is so crucial here. But when we pulled up at 8 yesterday morning, there were patients lined up waiting for us and they continued to arrive throughout the day. The team was kept very busy and enjoyed meeting and talking with so many seeking our help.

Doug had an audience during each of his procedures. Neil, who is a pre-med student at OSU, observed the first; Elizabeth, who is a third year nursing student at U of A, watched the second; and Shelby and Jordan were present during the third. Cindy, who circulated through the OR to be ready when Doug needed anything, instructed them in sterilization safety procedures and was able to narrate through each surgery so they would all know what they were looking at and what Doug was doing. The rest of the team will have an opportunity to observe in coming days.
Cindy’s face was alight with joy every time she left the OR. Her interaction with the Tanzanian nurses assisting in prep and care of the patients held a degree of give and take that is beyond anything we have experienced in the past. St. Mary’s is a small private hospital and is only manned by surgical staff when a surgery is scheduled—they will arrive and perform the procedure and then return to their jobs at other hospitals. When we have worked there the past two years, the OR was dedicated to our use, so there wasn’t any surgical staff with whom we could compare notes. Mazimbu has a full staff and they are very well trained. The exchange of knowledge is stimulating and exciting and is a benefit we did not anticipate.

Christopher’s skills in wound care were put to use yesterday when a patient arrived with a wound that required debriding and cleaning. And both he and Elizabeth have helped with injections, which leaves Cindy free to remain in surgery with Doug. God has brought together a team whose skills mesh and we are constantly reminded of the beauty of His plan.
Lingering long after dinner last night, the team discussed the day and solved the problems of the world. After a while, Jordan mentally tuned out of the discussion as she began making plans for the evening. After a quick check with Adam, a sleepover was arranged for Elizabeth and Shelby at Jordan’s room. The team is housed in 4 double rooms (Cindy and Elizabeth, Pati and Shelby, Doug and Glennis and Adam and Jordan) and 2 single rooms (Neil and Christopher). Adam and Jordan have the only double room that is actually a 2 bedroom and each of them have a full size bed. The girls enjoyed movie night on Adam’s laptop and then, because we must all sleep under mosquito netting and there is only one net per bed, all 3 girls slept together in Jordan’s bed. A good time was had by all.

The temperature this morning was the coolest we have seen, and the faint notes of a songbird singing a morning song followed us to breakfast. Being Saturday, we knew we would have a lighter day today. The hospital runs a much smaller crew on the weekend and we did not have any additional patients arrive after noon. That meant we stayed just long enough to miss lunch at LJS, so we got to experience a local restaurant, the Oasis, and a local favorite, chips mayai, which is close to a french fry omelette. Yumm!

Tomorrow we travel to a Masai village for worship. Christopher has made arrangements to attend mass at a local Catholic church at 8 and will be joining us for the trip to the village. We are all looking forward to the day and will have lots to share with our families.

Peter

The pain in Peter’s belly was just a gnawing ache when he finished his day as a tractor driver last Friday. He passed up the dinner his wife had prepared for him and their six children and lay down, hoping for relief. By Sunday, the worm of pain coiled around his midsection and into his back and his concerned family took him to the hospital in Turiani.

Peter’s eldest brother, George, got a phone call on Monday with the news of his brother’s condition. When he did not get good news by Wednesday, he made the hour and a half trip from his home in Morogoro to Turiani, only to find that Peter had been released that day because the hospital did not know what was wrong.

Arriving at Peter’s house, George found his brother wracked with agony and realized he had walked the two kilometers from the hospital to his home. He quickly gathered his cousin and other brother to help transport Peter to Morogoro, and they arrived at their father’s home on the outskirts of Morogoro in the middle of the night.

Thursday morning, during the last leg into Morogoro, George decided to change his route from the large Regional hospital to Mazimbu, a smaller hospital that does not normally treat critical cases. When questioned about that choice, George said that he knew how things worked at the Regional hospital: hurry up and wait. By the time they arrived at Mazimbu, Peter’s pain was beyond endurance and his belly was noticeably distended. George believed he was bringing his brother in to die.

At the entrance, the receptionist asked “Why did you bring him here?” and the doctor told him to take Peter to the Regional hospital, saying “Your brother needs an emergency surgery.” George pleaded, asking him to reconsider. Dr. Kizuma recognized the severity of the problem and pulled Doug for a consultation. Would he be willing to assist? Doug readily agreed and together they did a procedure to address Peter’s massive intestinal blockage. The next day, Peter was smiling and complaining about the tube down his nose. Doug was very happy to know that was his only complaint—the abdominal pain was gone!

George said that God led them to Mazimbu.

This team very nearly aborted the surgical mission trip this year because of lack of medical personnel. Within days of the cutoff beyond which we would not be able to purchase airfare, God brought Adam onto the team. The addition of a second doctor allowed the trip to continue, which meant that Doug was at Mazimbu when Peter arrived in an acute condition, and made possible the surgery that saved his life. It is humbling to think of the perfection of God’s plan and we praise Him for His divine intervention in Peter’s life.

Thursday, July 29, 2010

Thursday at the hospital

Surgery on Thursday

The day started early for Doug and Adam, who were invited to join the staff doctors and nurses for morning report and called a taxi for the ride to Mazimbu. Four patients are currently in the hospital and both medical teams conferred on the best treatment plans. All of the medical staff learned from each other. Adam had some suggestions that surprised the Tanzanian doctors, who then made some changes to their plan of care. Doug mentioned he has learned how to improvise and do without, how to make the best of the situation. It was a very open exchange of knowledge and ideas and the collegial atmosphere was a welcome side effect of the meeting. We are excited at the foundation that is forming between the surgical team and the hospital staff. Tanzanians value relationships above everything. Americans tend to value justice. If we can bridge the cultural gulf and build a relationship with the staff here, it will open the door to future teams and allow this vital mission to continue.

Mazimbu hospital has resources we have not had available to us in the past. The lab is able to do many tests, including a complete blood count as prep for surgery, and there is an Xray machine and a radiologist on site. The ultrasound machine is not currently working, though, but Barbara has helped solve that problem. Two men and one woman from yesterday needed an ultrasound before Doug and Adam could decide how we can best help them. They were waiting for us when we arrived this morning and switched places with us in Barbara’s car. The radiologist joined them and off they went to Sua, where there is a functional ultrasound machine. This is an interesting process—the radiologist goes with the patient to read the ultrasound on site and returns with the patients to the hospital.

Our turnout for medical, non-surgical patients was lower today than we hoped. Adam was kept busy through lunch, but the team spent the afternoon chatting, getting to know our translators better and comparing the differences between our two countries. And Shelby and Jordan spent the afternoon learning Swahili from Geofrey, the translator who worked with them, and teaching each other games from their countries. Geofrey, who has just graduated from University and plans to be a teacher, is now proficient at hangman and rock/paper/scissors.

Doug has been very busy today, though, and was pulled in for an emergency procedure. A patient presented today with a severe bowel obstruction requiring immediate surgery, and the Tanzanian doctor asked Doug to scrub in and assist. The patient was in obvious pain as he was wheeled into the “major theatre” and two hours later the doctors were relieved to know that the procedure, which likely saved his life, was successful.

One humorous incident happened—the emergency procedure bumped two scheduled patients who were already prepped for their surgery and were patiently waiting, draped in a bed sheet for modesty. Once we realized both of them would have to be rescheduled for another day, Cindy and Pati went to discuss timing with them. When they walked into the room, only one man was waiting. When they searched the hospital for Yohana, he was nowhere to be found. The Matron of the hospital and her staff were recruited for the search and, after some rapid Swahili, reported to us that he had escaped. Hopefully, we will recapture him tomorrow!

Wednesday, July 28, 2010

Work begins at Mazimbu hospital

We met the staff at Mazimbu yesterday and introductions went very well. This is a new hospital for us. The private hospital that hosted our team the past two years, St. Mary’s, experienced a change in administration last year, and the new management is focused in other directions. Bishop Mameo, who heads the Morogoro diocese of the Evangelical Lutheran Church in Tanzania, worked with Barbara to find an alternate location for the team. So we are working with the government hospital in Mazimbu, an outlying area of Morogoro. The facilities are wonderfully clean, airy and spacious and the staff has welcomed us with warm smiles and Tanzanian hospitality.

In preparation for today, the team met last night to brainstorm logistics, weighing our new knowledge of the facilities with past methods that had helped streamline the flow of patients. It was decided that Cindy and Elizabeth, who have the most medical training after our doctors, would be the initial point of contact. We have learned from past years that some initial screening is very important. We want to work with the Tanzanian medical system and offer our skills in areas that are not routine. We do not want to see patients that need treatment for malaria, parasites or other common ailments, giving the impression that the Tanzanian doctors are not competent. That is certainly not the case! Cindy and Elizabeth are able to ask enough questions that they can direct those types of patients to the hospital for help from the staff doctors.
Patients were then guided to our registration desk, where Pati entered their information into our computers and organized the minor paperwork we are using for records. Jordan and Shelby then worked together to record their vitals and lead them to the waiting area for the doctor they would see. Doug consulted with all of the surgical cases that were referred from the Asbury Methodist team, making the final determination of whether surgery was indicated. All other non-surgical cases were seen by Adam, who would diagnose their conditions and prescribe treatment, sometimes referring it to Doug for surgical consideration. Neil worked with Adam to record his case notes and be available for any other help that might be needed.
And after the doctors were done with their examination, medicine was usually prescribed, which took them to our pharmacy, manned by Glennis and Christopher.

This flow worked very well for us today, especially since we had four translators, in addition to Barbara. Although we will make minor adjustments each day as we fine tune our procedures, the team left the hospital today knowing that we had worked well together, with our patients and with the hospital staff.

Tomorrow will see our first surgical cases. We have four procedures scheduled, beginning at 7:30. We know that we must be flexible—in Tanzania a schedule is only a rough draft and the only time it is firm is at the end of the day, when it is complete!

Monday, July 26, 2010

We arrive in Tanzania

After 2 full days of travelling, we arrived in Dar es Salaam Sunday evening on the last flight of the day into Tanzania. As we waited patiently for our visa that would allow us to enter the country, our rumpled clothes and sagging shoulders told the story of our journey. We gave a prayer of thanks that we all arrived safely, along with our 18 bags of personal items and medical supplies. Barbara Robertson, a Washington state resident who works for the ELCA and has been in Tanzania for more than 7 years, spotted us as we talked with the customs agent to explain the contents of our bags. Once he understood the bags were filled with medicines and supplies that were to be a gift to the Tanzania people, he waved us through. We exchanged hugs, greetings and introductions with Barbara and piled our luggage into two Land Rovers for the short drive to the Catholic guest house, where we stayed last night.

After a quick breakfast, the team helped rearrange the bags in the two vehicles. The plan was for us to split up today: Barbara would take Doug, Adam, Cindy and Jordan to the ministry of health in Dar es Salaam to present medical credentials for the licensed team members and the rest of the team would go to Morogoro and get settled in to our rooms at the Lutheran Junior Seminary. We were prepared for the possibility that meeting with the Tanzania officials could take all day, but after just a few hours, the paperwork was completed, the fees were paid, and the other half of the team began their drive to Morogoro, where we would be reunited by dinner time.

Tomorrow morning we will move our medical supplies to the hospital, meet the staff and our interpreters, and learn how we can best serve and show the love of Christ. We have already talked with Robert Spitaleri, who worked with Asbury Methodist last month, so we know that patients have been told to come see us beginning Wednesday,

Tuesday, July 13, 2010

In preparation for the third surgical mission trip to Tanzania, the team met for the first time on Saturday, two weeks before departure. We learned a little bit about each other and what we can expect over our two week stay in Tanzania. We all have much to do over the next two weeks but are excited at this opportunity to serve Christ and get to know our brothers and sisters in Tanzania.

2010 Travel Itinerary Tanzania Medical/Surgical Team

July 24, Saturday
Leave Fayetteville @ 10:54 am / leave Tulsa @ 10:45 am
Arrive Detroit @ 2:14 pm (1:14 pm) / arrive Detroit @ 2:13 pm (1:13 pm)
Leave Detroit @ 5:40 pm (4:40 pm)
July 25, Sunday
Arrive Amsterdam @ 7:35 am (12:35 am)
Leave Amsterdam @ 11:00 am (4:00 am)
Arrive Dar es Salaam @ 10:25 pm (2:25 pm)

August 8, Sunday
Leave Dar es Salaam @ 11:35 pm (3:35 pm)
August 9, Monday
Arrive Amsterdam @ 7:40 am (12:40 am)
Lv Amsterdam @ 12:55 pm (5:55 am) / lv Amsterdam @ 2:40 pm (7:40am)
Arrive Detroit @ 3:35 pm (2:35 pm) / arrive Minneapolis @ 4:35 pm
Leave Detroit @ 7:35 pm (6:35 pm) / Leave Minneapolis @ 9:30 pm
Arrive Fayetteville @ 8:58 pm / arrive Tulsa @ 11:28 pm

Times are local for the city (Times in parentheses are home times)
Fayetteville flights / Tulsa flights