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.
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