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Thursday, August 5, 2010

Final words

We have been kept very busy the past several days and arrived an hour and a half late for our dinner at LJS on Wednesday. By noontime yesterday, it was clear the surgery schedule would again keep us late, so we called LJS to tell them not to make dinner for us, which allowed us to visit the Arc hotel for our meal. A table was quickly arranged for the 11 of us on the patio with a breathtaking view of Mount Uluguru looming over the valley. Different dishes were sampled by the team and we enjoyed a relaxing several hours under the African stars. Surprisingly, the temperature dropped to the low 60’s as the evening waned and we actually became chilled. Everyone welcomed the quilts on our beds last night!

The invitation from the Aga Khan has expanded into two evenings that will involve the whole team. Adam will be speaking tonight, Thursday, and the entire team will be attending, along with two of our interpreters, Nova and Godfrey. After the presentation tonight, there will be a question and answer session, followed by socialization with “bitings”, the local word for appetizers.

The following night, the President of the community is hosting us in his home for dinner. Barbara has warned us that there is a definite class in the Muslim community and that there will be a high table that will include her, Cindy, Adam and Doug. The rest of the team is of a lower rank, so will be seated separately.

When Barbara spoke with the President yesterday, he marveled that there will be a group of Christians joining his group, saying that has never happened in his lifetime. He went on to say “But this is so important in our world today, that we learn to understand each other.” We are going in the hope that we can build a relationship that will allow us to show Christ.

Tomorrow will be our last day at Mazimbu, but it will be a very busy one. We had to move one surgery from today to tomorrow because the patient’s blood pressure was too high. That gives us five operations for tomorrow, which will take all day. The following day we arise at 5 am and after a short journey, we will see the sun rise over Mikume National Park. During our safari we will see the animals of Africa in their natural setting. And the following day, Sunday, we will worship at Bishop Mameo’s church in Morogoro before our return home begins with the 3 hour trip to Dar es Salaam. If time allows, we will post pictures from Mikume, but this will probably be the last blog we will have time to share.

Thank you for your prayers and support of this vital mission. Until we see you again, kwa heri, farewell.

Tuesday, August 3, 2010

Peter, the Tanzania applause and Joyce

After a great Sunday, we were well rested and ready for the crowd that awaited us yesterday morning. In anticipation of greater numbers, we shifted the team slightly to have Elizabeth and Christopher both work in our screening/triage area so we could get patients to Adam faster.

We were again delayed in starting surgeries, but Doug used the extra time to consult with patients to be evaluated for operations. Once the OR staff was ready for the first patient, it was after 9:30 am. But once they have begun in the OR, they move very quickly. Doug remarked that the turnaround time between procedures was so fast, he did not have time to complete even one surgical consult. The up side to this, though, was that all three scheduled patients were out of surgery before noon, which allowed an opening for another patient after lunch. And at about 11:30 am, when Doug was finishing the last procedure, a patient checked into triage who 1) needed a hernia corrected, 2) had not eaten yet that day and 3) had recent lab test results with a CBC with him. Presto, he is added to the schedule, prepped for surgery and in the OR before 1:30 pm. Now that’s speed.

During the day, the offsite lab we were using for our CBC experienced a breakdown of the machine used for that test. Barbara had been transporting the samples to that lab and bringing the results back. Quick consultation by phone with the Mazimbu docs suggested she take the samples to the Aga Khan center, which is a private Muslim hospital second only to the regional hospital in size. In talking to the hospital administrator, Barbara mentioned the work the medical team was doing at Mazimbu. When asked about the type of doctors on the team and told that one of them was an endocrinologist, the hospital administrator got very enthusiastic. After some discussion, an invitation was extended to have Adam come and speak with their faith community and stay to have dinner with them. Adam has readily accepted and will be speaking with them Thursday evening. What an amazing opportunity God has given us for a Christian doctor to speak and eat within the Muslim community!

As an endocrinologist, one of Adam’s primary areas of expertise is in management of diabetes, which is prevalent in this society. During the day yesterday, our luncheon host from Sokoine came to see Adam. He had been diagnosed with type 2 diabetes five years previously and was managing it by omitting the sugar from his chai tea, while continuing to drink his soft drinks daily. When Adam checked his blood sugar, the number was dangerously high at over 500. Normal is around 100. Adam immediately injected him with insulin and prescribed 3 shots daily for treatment.

As we were leaving for the day, we saw an wondrous site: Peter was up and walking, although slowly. His brothers William and George were by his side and the team applauded his amazing progress Tanzanian style—rubbing our hands for a few seconds as if warming them, then three loud claps in unison. We continue to praise God for the healing He has wrought in Peter’s life.
The morning today again began for our docs with a joint morning report at Mazimbu, after which Adam gave an agreed-upon presentation to the staff about type 1 and type 2 diabetes and ideas about how he would manage inpatients and outpatients in Tanzania. The presentation was very well received and the Matron and several others reported that they were glad to have the information. The longer morning report meant that we started late again, but the team has gotten better every day and we were able to quickly get a patient for Adam, with many more in the wings.

Pati was greeted at her desk as soon as she sat down by a patient who was seen the previous day. Adelita had bagged tomatoes, carrots and a cucumber and taken the time to write a 2 page letter to Pati thanking her for her service and the care and concern shown to her. She also gifted Pati with a hand-made drum in appreciation and Pati responded by taking the nail cross from her neck and draping it around Adelita’s neck. It was so good to know that we are successful at building relationships in Tanzania.

Adam is getting a wide variance of patients, utilizing his skills learned in his internal medicine residency that preceded his endocrinology fellowship. We have seen a burn patient, a woman that has not developed physically beyond childhood and other patients suffering with problems such as rheumatoid arthritis, asthma, pelvic infections, a blocked kidney, prostate problems, rashes, and many with diabetes or with high blood pressure.

Our burn patient today suffered severe burns over 30% of his body a year ago and has wounds that have not yet healed. Christopher and Elizabeth worked together to clean and debride his wounds and he will continue to seek followup treatment at a local wound center.

Our last surgical patient today was Joyce, a tiny 52 year old woman who had an abdominal mass larger than the size of a full term pregnancy. Joyce had been to many doctors seeking help over the 6 years she has suffered with this problem and all had turned her away. We, too, initially turned her away, referring her to a gynecologist. After reflecting about the problem overnight, though, the team agreed that Joyce was unlikely to get help from another doctor and that we might be her best hope. We had gotten the number of a relative and called to ask them to send her back in the following day. After reviewing an ultrasound and determining there were no apparent negative indications, we scheduled her for exploratory surgery and the gynecologist, Dr. Lyamuya agreed to come today to assist. Once Doug was able to get a good look inside, he worked with Dr. Lyamuya to remove an ovarian cyst that was estimated at 25 pounds and nearly filled a 5 gallon bucket.

Matron told us that there is a saying in Tanzania—if you travel long enough, the path will lead to God. And she said it meaning that God was at work in bringing us together with Joyce.

Sunday, August 1, 2010

Our day began at 9:45 with the trip to Sokoine for worship. We were warned to eat a hearty breakfast because services could last well into mid-afternoon. As we turned onto the dusty road that led to the church, the Masai turned to look at the wazungu, white folks. Children ran up to us waving and smiling and many Masai interrupted their visiting to personally welcome us, making sure to shake the hand of every one of us.

We were told that there was to be a wedding at the church today, and we were all curious to see this ceremony from a Masai point of view. Barbara told us the bride might choose traditional clothing, which would see her covered in beads, or a western style long white gown.
Tanzanian time is in full force in the Masai villages. The worship scheduled for 10:30 actually began at 11:30, which left time for refreshments. Benches were brought into the shade of a nearby tree and we were proudly offered sodas. Shortly after that, the villagers began making excited noises and we heard the honking of car horns as two vehicles pulled in to the church yard. The wedding party had arrived—and we quickly discovered this was to be a double wedding! Both brides wore long white gowns with veils.

Once it was time to start, we were ushered in and given seats up front with a great view of the services. We all stood for the procession of the wedding parties, which was a very slow affair with much ceremony. Both parties consisted of a bride and groom, the best man and the maid of honor, a flower girl and ring bearer and one attendant.

In celebration of the festivities, there were six choirs to add to the worship today, including a youth choir and several children’s choirs. The music at a Masai service is beyond description and we hope you all will get a chance to hear the recordings that accompany some of the videos shot by the team.

Because both of the grooms are evangelists with the Lutheran church here, the Bishop was on hand to lead the service, along with 2 visiting pastors and the local pastor of the church. We were glad we were warned about breakfast, because the service lasted until 3 pm. On the closing song, everyone moved outside into the church yard and circled around one of the church leaders. Two lengths of fabric that were donated were auctioned off, with the proceeds benefitting the church, and Pati was determined to walk away the owner of one of them. After a little bidding, it looked as if she would be the high bidder at 15,000 shillings, which is almost double the value. But at the last minute, a tall Masai man moved to stand next to her and entered the race. There was rapid bidding back and forth, with Barbara translating for Pati, who finally prevailed for 42,000 shillings.

Afterwards, we were given lunch in the home of the village chairman. Before the meal was brought in, 3 Masai men brought a pitcher of water with a basin to help us wash our hands, and Barbara said it is a very rare honor to be served by men.

We left for home filled with the sights and sounds of a day in a Masai village playing back through our minds, an experience we will never forget.