today was our last day at the hospital. tomorrow we will shop, eat, and pack and then board our planes back home.
i think i have a lot of thoughts about the trip, but i need a bit of time to reflect before posting. it has been a really great trip - full of learning, teaching, laughing.
today was a fairly typical day of clinic and rounding. we did make it to the canteen one last time. and, today, i braved chips my eye... the french fry omelette. it was actually very delicious. and, we said goodbye to our favorite canteen guy.
they decided to do a little mini-fumigation of the wards today. i think it more stunned the cockroaches rather than killed them. they just seem to move a little slower. i think a big fumigation is planned soon. we bid farewell to the cockroaches as well.
during afternoon rounds, we told the families that tomorrow we go back to america. it was hard to tell them we won't be there kesho (tomorrow), as it seems we have all grown accostumed to one another. they all say hello and goodbye and we attempt the same words in swahili. they see us run from the bugs and giggle and we watch them pay the bugs no attention. they each said thank you and goodbye and wished for our safe travels. we thanked them and said until next time to all the bright smiling faces.
chronicling the ups and downs, overs and unders, and forwards and backwards of three pediatric hematologist/oncologists helping to care for children with cancer in Tanzania
Friday, May 24, 2013
Thursday, May 23, 2013
only one more day at muhimbili...
it's thursday night. tomorrow is our final day at the hospital. we will give one more lecture this morning- we decided to end with fever and neutropenia instead of palliative care... it seemed better that way. what's a better way to say goodbye than a little lecture on fever and neutropenia?
we spent the morning in clinic and rounding (clinic included a fairly exciting spinal tap with wriggly little one... i was just the assistant, thank goodness). then, this afternoon, we got to go see the hostel (the tanzania ronald mcdonald house equivalent sort of). the parents and patients who live too far from the city stay here when they aren't inpatient. there are nice rooms, toilets, classrooms, and a room where the mammas make jewelery and bags to sell to raise money. it was nice to see the place that they are so eager to get to when they are on the inpatient ward. and, we all picked up some great jewelery.
we took a lot of pictures of the kids this afternoon- and, they love it! they love to get a picture taken, look at the picture, get another picture, look at that one- over and over and over again. i still can't quite get them posted but when i get home, i will put them up here...
we completed our lecture blitz yesterday- we talked to the pediatric residents about leukemia, lymphoma, wilm's tumor, rhabdomyosarcoma, osteosarcoma, ewing's sarcoma, neuroblastoma. and, it was kind of entertaining- we got really stuck on the staging of hodgkins. they all had out their textbook making sure we were saying the right stuff. and, they had lots of great questions. it was a little exhausting for all involved, but i think overall it was helpful. between sue's lecture and ours, we have drummed up some business. one of the residents has sent over 5 or so new patients...
i don't think i ever blogged about the fun island we went to last weekend... we took a little dinghy to a bigger boat which took us to an island off the coast of dar - bongoyo island. there was a lovely beach and several little umbrella things to sit under. we ordered fresh bbq'd prawns and sat in the shade. we swam in the ocean and met someone from orcas island! it was a great way to spend the afternoon.
tonight, we are waiting for the fundi to come back to see how our dresses are coming along... we'll see...
tomorrow, we will round and go to clinic, say goodbye to all the staff and kids. i think it will be a little hard to say goodbye to all these wonderful little ones. and, it will be hard not to know what will happen next for them.
saturday, we plan to eat and shop until it's time to head home! we have to fill up our suitcases that were filled with supplies on our way here- so shopping is a necessity!
we spent the morning in clinic and rounding (clinic included a fairly exciting spinal tap with wriggly little one... i was just the assistant, thank goodness). then, this afternoon, we got to go see the hostel (the tanzania ronald mcdonald house equivalent sort of). the parents and patients who live too far from the city stay here when they aren't inpatient. there are nice rooms, toilets, classrooms, and a room where the mammas make jewelery and bags to sell to raise money. it was nice to see the place that they are so eager to get to when they are on the inpatient ward. and, we all picked up some great jewelery.
we took a lot of pictures of the kids this afternoon- and, they love it! they love to get a picture taken, look at the picture, get another picture, look at that one- over and over and over again. i still can't quite get them posted but when i get home, i will put them up here...
we completed our lecture blitz yesterday- we talked to the pediatric residents about leukemia, lymphoma, wilm's tumor, rhabdomyosarcoma, osteosarcoma, ewing's sarcoma, neuroblastoma. and, it was kind of entertaining- we got really stuck on the staging of hodgkins. they all had out their textbook making sure we were saying the right stuff. and, they had lots of great questions. it was a little exhausting for all involved, but i think overall it was helpful. between sue's lecture and ours, we have drummed up some business. one of the residents has sent over 5 or so new patients...
i don't think i ever blogged about the fun island we went to last weekend... we took a little dinghy to a bigger boat which took us to an island off the coast of dar - bongoyo island. there was a lovely beach and several little umbrella things to sit under. we ordered fresh bbq'd prawns and sat in the shade. we swam in the ocean and met someone from orcas island! it was a great way to spend the afternoon.
tonight, we are waiting for the fundi to come back to see how our dresses are coming along... we'll see...
tomorrow, we will round and go to clinic, say goodbye to all the staff and kids. i think it will be a little hard to say goodbye to all these wonderful little ones. and, it will be hard not to know what will happen next for them.
saturday, we plan to eat and shop until it's time to head home! we have to fill up our suitcases that were filled with supplies on our way here- so shopping is a necessity!
Tuesday, May 21, 2013
goodbye mr rat.
nameeta and i hadn't seen the rat that sue saw her first week here. until today. he unfortunately died and was swept up into a corner until he was disposed of... maybe he got into some chemo? hopefully he was a he and didn't leave any little ones behind...
this morning, sue gave a kind of grand rounds- a lecture to the interns, residents, and some consultants (no medical students as they have been granted a "breather" for the next two weeks to study for exams). she discussed what to do/what to think about when you are worried a patient has cancer. soon after her lecture, two new patients were delivered from the general pediatric ward as her lecture set off alarm bells in the doctors head... we will see what they have.
nameeta and i were charged this morning with preparing several lectures for the interns/residents to take place tomorrow afternoon... so, we are working on getting those together - in addition to our usual morning lecture. hopefully we can find some previously created lectures in our stash that we brought with us.
last evening, a fundi (a worker of any sort- this one happened to be a tailor) came to the apartment to make dresses out of the materials we bought while on our bike tour (did i already write about this? i am having deja vu). anyway, we giggled our way through the measurements. he is going to bring the dresses by on thursday for a fitting and they will be done by the time we leave on saturday!
nameeta and i spent the afternoon today gathering together the information we have collected in our mini chart review- hoping to give the doctors here some information on their patients and areas of successes and areas of challenges. it has been interesting to read through the charts and see how children present to medical care and the challenges surrounding that.
ok i must go... lectures are not preparing themselves.
this morning, sue gave a kind of grand rounds- a lecture to the interns, residents, and some consultants (no medical students as they have been granted a "breather" for the next two weeks to study for exams). she discussed what to do/what to think about when you are worried a patient has cancer. soon after her lecture, two new patients were delivered from the general pediatric ward as her lecture set off alarm bells in the doctors head... we will see what they have.
nameeta and i were charged this morning with preparing several lectures for the interns/residents to take place tomorrow afternoon... so, we are working on getting those together - in addition to our usual morning lecture. hopefully we can find some previously created lectures in our stash that we brought with us.
last evening, a fundi (a worker of any sort- this one happened to be a tailor) came to the apartment to make dresses out of the materials we bought while on our bike tour (did i already write about this? i am having deja vu). anyway, we giggled our way through the measurements. he is going to bring the dresses by on thursday for a fitting and they will be done by the time we leave on saturday!
nameeta and i spent the afternoon today gathering together the information we have collected in our mini chart review- hoping to give the doctors here some information on their patients and areas of successes and areas of challenges. it has been interesting to read through the charts and see how children present to medical care and the challenges surrounding that.
ok i must go... lectures are not preparing themselves.
Monday, May 20, 2013
muzungu sana and muzungu kidogo hit the big city on two wheels!
i'm sorry for the delay in posting, we have had a very busy few days... so, get ready for some updates.
Saturday:
nameeta and i got up and caught a taxi to a building not far from here. Nameeta's in charge of getting taxis and negotiating the price. we decided that i should hide in the bushes while she negotiates since they think she's a local and won't charge her a muzungu price. we hopped in and off we sped...going way too fast down the chicken lane. i almost asked him to slow down but decided to just close my eyes and hope for the best. we arrived safely and located our bicycle tour guide and the bicycles. the bikes were in pretty ok shape. the guide took the one with the fringe on the back of the seat that i'm pretty sure nameeta was eyeing. we strapped on our helmets and off we went. we started at 8:30 am...
the first stop was at a few of the second hand shops. the shop owners go to the bigger, more chaotic second hand market, purchase items inexpensively, and then bring them back to their stores to clean them and mark up the prices to sell to people who don't want to go the chaos of the second hand market. there were some pretty awesome shoes... very tall and very brightly colored.
the second stop was at a...coffee shop of sorts. men were grinding coffee beans and making fresh, strong coffee. they make the coffee and then carry it in the pot around the city selling it to people passing by. rather than having sugar to put in the coffee, they make fresh peanut brittle and sell that as a sweet. we watched them make both things, and then we tasted it... i didn't care much for the coffee but nameeta loved it! but, i did really like the peanut brittle. it was perfect - just enough sweet... there were several kids there that were running around and playing, and checking out the visitors. the chickens and roosters were up to the same thing...
the third stop was at the chapati/chai container...literally, there was a container (like off of a ship), where windows were cut out and a woman was making chapati and chai. the chai was perfectly spicey, and the chapati was fresh and hot. the woman making them had a bright face with a nice smile and big hoop earrings.
hmmm, somwhere in there, we went through the ghost market - an open market that the government built but then the taxes were too high so no one used it - hence the name ghost... but then the taxes were lowered, so people are starting to use it.
as we were riding our bikes on very bumpy roads, children would come running out of the houses chanting mu-zun-gu, mu-zun-gu, mu-zun-gu, and then they would run up to us and give us "knuckles" on our bikes, and then run after us until it was too far. i wish i had a picture of us being chased by children chanting muzungu, but the one in my brain is pretty bright.
ok, next stop... a traditional house- a 6 room house, each room contains one family - maybe up to 6 or so people, then a veranda where everyone sits for food or entertainment, and then one washroom. we went inside and saw how cramped the space is... and, we were told about the soap opera like drama that can develop in these tight living quarters... we ran into several little children here- all saying, take my picture. so cute.
then, on to the herbalist/midwife/doormat maker whose friend also makes paper mache roosters... very normal. we learned about different plants for fever, seizures, constipation, malaria. and, we learned how to make paper mache animals.... all very handy lessons, i think.
we next met the man selling herbs and such at the witch doctor store (his brother is the witch doctor but he was out). we smelled a few different items, but we were trying to get him to give us some love potion...it seemed kind of like an interesting pursuit. but, only the witch doctor can give that out apparently.
this was followed by a trip to the kanga shop where we picked out several fabrics. our guide, a very nice young man patiently translated each saying on the fabric as we held them out. and, he thoughtfully helped us decide which one was best for each of us. he said we spent a very long time in the shop... but, we left with several kangas and tonight, a man came to the apartment and is making clothing for us tonight.
then, we went to the cinema. not really a 12 screen or 10 screen or 8 screen cinema... more like benches and a 24 inch TV with a make shift stereo system playing a bollywood movie with swahili translation very loudly. it was hot and sweaty in there, but we took this opportunity out of the sun to re-apply our sunscreen. i lathered on my lotion and nameeta used her spray container. the locals were quite confused at our sunscreen and thought nameeta's was perfume. one woman looked accusingly at her husband asking why she couldn't have sunscreen. i explained to them how i was going to get skin cancer if i got a sunburn... and, then they looked at nameeta and said she wasn't all that muzungu... and thus we were named muzungu sana - very white and muzungu kidogo - just a little white.
ok, next... oh the other market where there was so much fruit and beans and rice and corn and peppers and people. people everywhere wanting to get their pictures with us. one particular man, yelled out in swahili that he wanted me to come sit with him as i could be his ticket to america!! there was extensive talking involved which ultimately led to me sitting on a pile of oranges with him posing for a picture... i hope that doesn't mean we are somehow married.
we then went to the secondhand market where they were selling all the stuff they sell in the first place we visited. i have never seen so many bras and underwear... and i was worried about having enough!!
i think our last stop was to get a soda and chat with our guide. he was really a great guy and full of information and made sure we were always safe. our tour lasted until 1:30, and we left feeling like we had gotten a great experience of the city and people.
then, we went to the golden tulip to swim in their infinity pool, surrounded by people in questionable bathing attire.
sunday, after rounding, we went to an island! an uninhabited island! so great...
more about this later...dinner is ready!
Saturday:
nameeta and i got up and caught a taxi to a building not far from here. Nameeta's in charge of getting taxis and negotiating the price. we decided that i should hide in the bushes while she negotiates since they think she's a local and won't charge her a muzungu price. we hopped in and off we sped...going way too fast down the chicken lane. i almost asked him to slow down but decided to just close my eyes and hope for the best. we arrived safely and located our bicycle tour guide and the bicycles. the bikes were in pretty ok shape. the guide took the one with the fringe on the back of the seat that i'm pretty sure nameeta was eyeing. we strapped on our helmets and off we went. we started at 8:30 am...
the first stop was at a few of the second hand shops. the shop owners go to the bigger, more chaotic second hand market, purchase items inexpensively, and then bring them back to their stores to clean them and mark up the prices to sell to people who don't want to go the chaos of the second hand market. there were some pretty awesome shoes... very tall and very brightly colored.
the second stop was at a...coffee shop of sorts. men were grinding coffee beans and making fresh, strong coffee. they make the coffee and then carry it in the pot around the city selling it to people passing by. rather than having sugar to put in the coffee, they make fresh peanut brittle and sell that as a sweet. we watched them make both things, and then we tasted it... i didn't care much for the coffee but nameeta loved it! but, i did really like the peanut brittle. it was perfect - just enough sweet... there were several kids there that were running around and playing, and checking out the visitors. the chickens and roosters were up to the same thing...
the third stop was at the chapati/chai container...literally, there was a container (like off of a ship), where windows were cut out and a woman was making chapati and chai. the chai was perfectly spicey, and the chapati was fresh and hot. the woman making them had a bright face with a nice smile and big hoop earrings.
hmmm, somwhere in there, we went through the ghost market - an open market that the government built but then the taxes were too high so no one used it - hence the name ghost... but then the taxes were lowered, so people are starting to use it.
as we were riding our bikes on very bumpy roads, children would come running out of the houses chanting mu-zun-gu, mu-zun-gu, mu-zun-gu, and then they would run up to us and give us "knuckles" on our bikes, and then run after us until it was too far. i wish i had a picture of us being chased by children chanting muzungu, but the one in my brain is pretty bright.
ok, next stop... a traditional house- a 6 room house, each room contains one family - maybe up to 6 or so people, then a veranda where everyone sits for food or entertainment, and then one washroom. we went inside and saw how cramped the space is... and, we were told about the soap opera like drama that can develop in these tight living quarters... we ran into several little children here- all saying, take my picture. so cute.
then, on to the herbalist/midwife/doormat maker whose friend also makes paper mache roosters... very normal. we learned about different plants for fever, seizures, constipation, malaria. and, we learned how to make paper mache animals.... all very handy lessons, i think.
we next met the man selling herbs and such at the witch doctor store (his brother is the witch doctor but he was out). we smelled a few different items, but we were trying to get him to give us some love potion...it seemed kind of like an interesting pursuit. but, only the witch doctor can give that out apparently.
this was followed by a trip to the kanga shop where we picked out several fabrics. our guide, a very nice young man patiently translated each saying on the fabric as we held them out. and, he thoughtfully helped us decide which one was best for each of us. he said we spent a very long time in the shop... but, we left with several kangas and tonight, a man came to the apartment and is making clothing for us tonight.
then, we went to the cinema. not really a 12 screen or 10 screen or 8 screen cinema... more like benches and a 24 inch TV with a make shift stereo system playing a bollywood movie with swahili translation very loudly. it was hot and sweaty in there, but we took this opportunity out of the sun to re-apply our sunscreen. i lathered on my lotion and nameeta used her spray container. the locals were quite confused at our sunscreen and thought nameeta's was perfume. one woman looked accusingly at her husband asking why she couldn't have sunscreen. i explained to them how i was going to get skin cancer if i got a sunburn... and, then they looked at nameeta and said she wasn't all that muzungu... and thus we were named muzungu sana - very white and muzungu kidogo - just a little white.
ok, next... oh the other market where there was so much fruit and beans and rice and corn and peppers and people. people everywhere wanting to get their pictures with us. one particular man, yelled out in swahili that he wanted me to come sit with him as i could be his ticket to america!! there was extensive talking involved which ultimately led to me sitting on a pile of oranges with him posing for a picture... i hope that doesn't mean we are somehow married.
we then went to the secondhand market where they were selling all the stuff they sell in the first place we visited. i have never seen so many bras and underwear... and i was worried about having enough!!
i think our last stop was to get a soda and chat with our guide. he was really a great guy and full of information and made sure we were always safe. our tour lasted until 1:30, and we left feeling like we had gotten a great experience of the city and people.
then, we went to the golden tulip to swim in their infinity pool, surrounded by people in questionable bathing attire.
sunday, after rounding, we went to an island! an uninhabited island! so great...
more about this later...dinner is ready!
Saturday, May 18, 2013
Saturday at Muhimbili
Hi all!
Nameeta and Kristina are off at Muhimbili today (it's Sunday morning) and I'm home getting ready to do some paperwork stuff (an organizational plan for the ward after we leave and a presentation for Grand Rounds--yes I now get a crack at the infamous grand rounds of the earlier post) so I thought I'd fill you in on Saturday at Muhimbili (because, yes, I'm procrastinating on the other tasks)!
So, pole sana (very sorry), Edwin didn't show up to get me on Saturday morning. I'm not sure what happened, maybe the bajaji is still broken, but he usually sends someone else then. Anways, at 8:45 I decided I better get walking or finding a taxi on the road. No taxis to be found and it wasn't that hot and no rain so walking it was! I did walk mzungu-style because I was late. We've figured out why the locals all walk slow, they don't get hot--and mzungu-style fast walking makes you sweat a lot. So we try not to walk Mzungu-style but no choice today!
The best thing was that the patient Kristina wrote about with likely T-cell ALL and a mediastinal mass who had been febrile and looking terrible for a couple of days looked wonderful on my arrival (after a rather large desperation dose of IV Dexamethasone the night before). Mom reports no more fevers and greatly reduced pain and her breathing is much better. Now, for those oncologists out there, her labs were not yet back in the evening so hopefully the kidneys did ok, I guess Kristina and Nameeta will find out today. Our other new AYA leukemia patient also was feeling much better after his first appropriate dose of dexamethasone, so a good start to Saturday.
Rounding was uneventful--pretty much anyway. And then when we finish on Upendo(the "sick" ward) then we go to the nurses office and the Tumaini (the more well ward) parents come find us if there are issues. So there were a few issues. An outpatient waiting on chemo came with a new CBC which wasn't good enough so there was an extensive conversation. Then another outpatient, a little girl only a month or so into Wilm's tumor treatment came with her mother and mom reported that they were going to discontinue treatment to go home to pray for healing. We tried to discuss but mom's mind seemed made up. Very sad because she was doing well.
Then I had a brief break and a couple of kids decided to hold my hand and walk me around the unit. One was our very sick Hodgkin's patient from when I started who looked VERY bad and now looks great! Yeah chemo! We were walking and then the food trolley came along which means they are getting close to handing out lunch. She dragged me back to her room and woke her mama from a dead sleep shouting in Swahili what I can only assume meant it's lunch time! The mamas came running to get in line but they weren't quite ready to hand out lunch so they all laughed at the little girl. I think it's been quite some time since she has had a good appetite so it's nice to see and all of her swelling has gone done and she now wears all her pretty dresses again!
Then we moved on to chemo in the spinal fluid--these were left over from Friday. I can only say that I've not seen anything quite like it. The chemo was not really labelled and we had to deduce the doses. We didn't have the right doses for sme kids (so no-go) and we had more chemo than charts but we managed to give IT (intrathecal chemo) to about 5-6 kids including our new 18 year old with leukemia. Thankfully another teen had just gotten one because the new patient had no idea what we were talking about (and the Tanzanian attending had explained it) so he felt better seeing that other teen.
Oh, I forgot before ITs 2 new patients with very large abdomens showed up in on the ward with no warning. One seems to have the largest Wilm's tumor we've seen and not sure about the other one. So we got that organized-sort of.
Then during ITs someone with fever came in from outpatient and didn't look so good and we spent the better part of the next 2 hours trying unsuccessfully to get an IV in. I tried (now that's not saying much), Lulu, the Tanzanian attending tried a lot, and then the Tanzanian resident tried. Finally, we sent him to the emergency department to plead for help. We left then, I hope he got a line, we sent the antibiotics with him so he'd get them ASAP (well not so ASAP from the fever but when the line was in).
Lulu brought me home and then I managed to find my way to meet the girls for dinner after their lovely day experiencing Dar! Wait until you see the pics!
Nameeta and Kristina are off at Muhimbili today (it's Sunday morning) and I'm home getting ready to do some paperwork stuff (an organizational plan for the ward after we leave and a presentation for Grand Rounds--yes I now get a crack at the infamous grand rounds of the earlier post) so I thought I'd fill you in on Saturday at Muhimbili (because, yes, I'm procrastinating on the other tasks)!
So, pole sana (very sorry), Edwin didn't show up to get me on Saturday morning. I'm not sure what happened, maybe the bajaji is still broken, but he usually sends someone else then. Anways, at 8:45 I decided I better get walking or finding a taxi on the road. No taxis to be found and it wasn't that hot and no rain so walking it was! I did walk mzungu-style because I was late. We've figured out why the locals all walk slow, they don't get hot--and mzungu-style fast walking makes you sweat a lot. So we try not to walk Mzungu-style but no choice today!
The best thing was that the patient Kristina wrote about with likely T-cell ALL and a mediastinal mass who had been febrile and looking terrible for a couple of days looked wonderful on my arrival (after a rather large desperation dose of IV Dexamethasone the night before). Mom reports no more fevers and greatly reduced pain and her breathing is much better. Now, for those oncologists out there, her labs were not yet back in the evening so hopefully the kidneys did ok, I guess Kristina and Nameeta will find out today. Our other new AYA leukemia patient also was feeling much better after his first appropriate dose of dexamethasone, so a good start to Saturday.
Rounding was uneventful--pretty much anyway. And then when we finish on Upendo(the "sick" ward) then we go to the nurses office and the Tumaini (the more well ward) parents come find us if there are issues. So there were a few issues. An outpatient waiting on chemo came with a new CBC which wasn't good enough so there was an extensive conversation. Then another outpatient, a little girl only a month or so into Wilm's tumor treatment came with her mother and mom reported that they were going to discontinue treatment to go home to pray for healing. We tried to discuss but mom's mind seemed made up. Very sad because she was doing well.
Then I had a brief break and a couple of kids decided to hold my hand and walk me around the unit. One was our very sick Hodgkin's patient from when I started who looked VERY bad and now looks great! Yeah chemo! We were walking and then the food trolley came along which means they are getting close to handing out lunch. She dragged me back to her room and woke her mama from a dead sleep shouting in Swahili what I can only assume meant it's lunch time! The mamas came running to get in line but they weren't quite ready to hand out lunch so they all laughed at the little girl. I think it's been quite some time since she has had a good appetite so it's nice to see and all of her swelling has gone done and she now wears all her pretty dresses again!
Then we moved on to chemo in the spinal fluid--these were left over from Friday. I can only say that I've not seen anything quite like it. The chemo was not really labelled and we had to deduce the doses. We didn't have the right doses for sme kids (so no-go) and we had more chemo than charts but we managed to give IT (intrathecal chemo) to about 5-6 kids including our new 18 year old with leukemia. Thankfully another teen had just gotten one because the new patient had no idea what we were talking about (and the Tanzanian attending had explained it) so he felt better seeing that other teen.
Oh, I forgot before ITs 2 new patients with very large abdomens showed up in on the ward with no warning. One seems to have the largest Wilm's tumor we've seen and not sure about the other one. So we got that organized-sort of.
Then during ITs someone with fever came in from outpatient and didn't look so good and we spent the better part of the next 2 hours trying unsuccessfully to get an IV in. I tried (now that's not saying much), Lulu, the Tanzanian attending tried a lot, and then the Tanzanian resident tried. Finally, we sent him to the emergency department to plead for help. We left then, I hope he got a line, we sent the antibiotics with him so he'd get them ASAP (well not so ASAP from the fever but when the line was in).
Lulu brought me home and then I managed to find my way to meet the girls for dinner after their lovely day experiencing Dar! Wait until you see the pics!
day off = awesome...
we will post more soon, but right now we must go to bed as the sun zapped all of our energy during our amazing day off!!
the bike tour was so great- we saw a lot of the city and were chased by children chanting muzungu muzungu muzungu take my picture... so, maybe tomorrow i'll get some pictures up if i can make it happen.
we spent the afternoon at the golden tulip hotel at their pool. so nice. and then, we had a lovely dinner watching the sun set! so great!!
off to bed now and then rounding tomorrow. and, hopefully we'll get back to the golden tulip tomorrow afternoon for another dip in the pool!
the bike tour was so great- we saw a lot of the city and were chased by children chanting muzungu muzungu muzungu take my picture... so, maybe tomorrow i'll get some pictures up if i can make it happen.
we spent the afternoon at the golden tulip hotel at their pool. so nice. and then, we had a lovely dinner watching the sun set! so great!!
off to bed now and then rounding tomorrow. and, hopefully we'll get back to the golden tulip tomorrow afternoon for another dip in the pool!
Friday, May 17, 2013
chitty chitty bang bang goes boom boom
Our Friday got off to a rough start to say the least. Edwin promptly arrived and off we flew! We made the traffic light right turn at the busy road which takes us to Muhimbili and we all cheered...but as fast as we were zooming little did we know trouble lied ahead.
All of a sudden as the breeze was cooling our faces, we heard a hiss sound from the Bajaji. Ohhh no! Edwin turned around to look at the right tire and sadly we had a flat tire. The bajaji was tilting toward the side I was sitting on and Kristina had to keep holding me in on all the turns! We were just pulling into Muhumbili hospital and Edwin insisted on driving us to the drop off round-about at Jengo lawatoto (Home of the Children)...such a nice man. We arrived safely and soundly...Hopefully Edwin was able to fix the flat tire and had lots of good business today.
Today we went to Grand Rounds, Tanzania style. One of the 3rd year pediatric residents presented a case of a young girl with a mediastinal mass and impressive cervical lymphadenopathy. The room was packed with medical students, interns, residents, consultants (general pediatricians), and specialists. When we introduced ourselves everyone giggled and laughed....were they laughing at the muzungus??? Nope. Apparently we just sat in the intern section! The grand rounds was a clinical presentation of our patient who had Hodgkin's lymphoma and the resident was heavily critiqued on everything from her sentence structure to her physicial exam skills. It was intense!
After grand rounds, we returned to the ward to check on a sick patient in respiratory distress. When we returned, we saw him take his last breath. We removed his 02, closed his eyes, and said goodbye. Just his aunt was with him and she had to call his parents who live 10 hours away. It was very sad. We still don't know what he had and may never know.
I spent the day in the outpatient clinic and it was very busy. Patients quietly wait in the lobby outside and all have numbers. One comes in and we signal for the second patient to come in at the same time. So basically you are seeing two patients at once....HIPAA does not exist. The highlight of the clinic was when a child who was 2 years off therapy for Wilm's tumor showed up with his file (chart) and large lumps around his jaw...MUMPS!!! yikes! We ushered him to the now empty lobby and got him taken care of without further exposure to the immunocompromised children.
Tomorrow Kristina and I are off on a bike tour through local parts of Dar-es-Salaam then relaxing by a beautiful beach in the afternoon!
All of a sudden as the breeze was cooling our faces, we heard a hiss sound from the Bajaji. Ohhh no! Edwin turned around to look at the right tire and sadly we had a flat tire. The bajaji was tilting toward the side I was sitting on and Kristina had to keep holding me in on all the turns! We were just pulling into Muhumbili hospital and Edwin insisted on driving us to the drop off round-about at Jengo lawatoto (Home of the Children)...such a nice man. We arrived safely and soundly...Hopefully Edwin was able to fix the flat tire and had lots of good business today.
Today we went to Grand Rounds, Tanzania style. One of the 3rd year pediatric residents presented a case of a young girl with a mediastinal mass and impressive cervical lymphadenopathy. The room was packed with medical students, interns, residents, consultants (general pediatricians), and specialists. When we introduced ourselves everyone giggled and laughed....were they laughing at the muzungus??? Nope. Apparently we just sat in the intern section! The grand rounds was a clinical presentation of our patient who had Hodgkin's lymphoma and the resident was heavily critiqued on everything from her sentence structure to her physicial exam skills. It was intense!
After grand rounds, we returned to the ward to check on a sick patient in respiratory distress. When we returned, we saw him take his last breath. We removed his 02, closed his eyes, and said goodbye. Just his aunt was with him and she had to call his parents who live 10 hours away. It was very sad. We still don't know what he had and may never know.
I spent the day in the outpatient clinic and it was very busy. Patients quietly wait in the lobby outside and all have numbers. One comes in and we signal for the second patient to come in at the same time. So basically you are seeing two patients at once....HIPAA does not exist. The highlight of the clinic was when a child who was 2 years off therapy for Wilm's tumor showed up with his file (chart) and large lumps around his jaw...MUMPS!!! yikes! We ushered him to the now empty lobby and got him taken care of without further exposure to the immunocompromised children.
Tomorrow Kristina and I are off on a bike tour through local parts of Dar-es-Salaam then relaxing by a beautiful beach in the afternoon!
sorry we missed thursday...
apparently we were too tired to blog yesterday. i think we ate dinner and then all chatted for a while - debriefing on our experiences here. and by the time that was over, bed seemed better than blogging... sorry mom.
nameeta will be blogging momentarily about another bajaji event as well as our experiences with some of the teaching here at the hospital... it was memorable and amazing, but i'll let her blog about it.
this week, i have been rounding in tumaini- the ward that holds the children who are less ill, mostly receiving chemotherapy. every day, i ask, can they go home? the children are here for so long because they often come from so many miles away that going home in between cycles of chemotherapy isn't feasible. and the hostel is full, so they end up staying on the ward for a long time. but, they form little family units, and they all support one another, watch out for one another, make sure each other have what they need. they seem to almost move and do things as a unit- like there is this unspoken rhythm of life. get up, get breakfast, wait for the doctors to round, get lunch, check temperatures, get new IV's placed, get dinner, and on and on. the kids run around and everyone watches out for each other. there are definitely a few trouble makers - chasing after the other kids. i think i saw one kid bite another today - but the other kid was stealing his red car so maybe it was warranted?
this afternoon, i was called to the bedside of a little girl with ? t cell leukemia? - she has a large mediastinal mass and severe anemia and significant fevers. she had a fever and was not breathing well. her oxygen levels were low. we re-positioned her and put oxygen on. at home, i would have put her on some sort of positive pressure ventilation, but here there's just an oxygen mask. she was staring at me with these big eyes, like what the heck is going on and can't you make me feel better. and, it was so frustrating and sad not to have the resources to help her. but, with some lasix and morphine and tylenol and ibuprofen (don't worry, her platelets were ok), she improved a bit. hopefully, her steroid will kick in soon.
during afternoon rounds, one of the doctors picked up a chart and a zillion baby cockroaches came flying out... a new generation joins the crew...
we did get to hear one little guy give us a big "hello" this afternoon - he had a tracheostomy placed due to his tumor obstructing his airway a while ago... but with some chemo, the tumor shrunk and his trach came out a few days ago. he's been shy to talk, but today we encouraged him to say hello and he did - which prompted all of us to cheer!
tomorrow, nameeta and i are taking the day off and going on a bike tour of Dar! (don't worry, mom, it's very safe). i'm super excited! and, then we are headed to the beach!
more to come from nameeta momentarily...
nameeta will be blogging momentarily about another bajaji event as well as our experiences with some of the teaching here at the hospital... it was memorable and amazing, but i'll let her blog about it.
this week, i have been rounding in tumaini- the ward that holds the children who are less ill, mostly receiving chemotherapy. every day, i ask, can they go home? the children are here for so long because they often come from so many miles away that going home in between cycles of chemotherapy isn't feasible. and the hostel is full, so they end up staying on the ward for a long time. but, they form little family units, and they all support one another, watch out for one another, make sure each other have what they need. they seem to almost move and do things as a unit- like there is this unspoken rhythm of life. get up, get breakfast, wait for the doctors to round, get lunch, check temperatures, get new IV's placed, get dinner, and on and on. the kids run around and everyone watches out for each other. there are definitely a few trouble makers - chasing after the other kids. i think i saw one kid bite another today - but the other kid was stealing his red car so maybe it was warranted?
this afternoon, i was called to the bedside of a little girl with ? t cell leukemia? - she has a large mediastinal mass and severe anemia and significant fevers. she had a fever and was not breathing well. her oxygen levels were low. we re-positioned her and put oxygen on. at home, i would have put her on some sort of positive pressure ventilation, but here there's just an oxygen mask. she was staring at me with these big eyes, like what the heck is going on and can't you make me feel better. and, it was so frustrating and sad not to have the resources to help her. but, with some lasix and morphine and tylenol and ibuprofen (don't worry, her platelets were ok), she improved a bit. hopefully, her steroid will kick in soon.
during afternoon rounds, one of the doctors picked up a chart and a zillion baby cockroaches came flying out... a new generation joins the crew...
we did get to hear one little guy give us a big "hello" this afternoon - he had a tracheostomy placed due to his tumor obstructing his airway a while ago... but with some chemo, the tumor shrunk and his trach came out a few days ago. he's been shy to talk, but today we encouraged him to say hello and he did - which prompted all of us to cheer!
tomorrow, nameeta and i are taking the day off and going on a bike tour of Dar! (don't worry, mom, it's very safe). i'm super excited! and, then we are headed to the beach!
more to come from nameeta momentarily...
Wednesday, May 15, 2013
you're going to eat what??
today, one of the nurses proclaimed she was going to eat one of the crickets/grasshopper/giant green bugs that hang out around the hospital and the city in general. i don't know if she was teasing us or was serious - she literally had it (dead and kinda of dried?) behind her ear and was saving it for later!! but, since we generally jump at the sight of all bugs, she may have been teasing us. i don't want to eat any bugs while i'm here (i feel it necessary to make that statement known).
we went to a new canteen yesterday - a sit down meal. i had rice and veggies and the ever bold nameeta had chips my eye - which is a french fry omelet! i think she really liked it. we went back today for more rice and veggies. we have become pretty tight with the guy who runs the place. besties for life, i'm sure.
we still have a few kids on the ward who we are waiting for diagnoses on.... supporting them hopefully until we can figure out how to treat them. this morning, we had an eventful moment with a little septic shock, which we managed to manage... the kid was eating chicken soup by this afternoon! these children are quite resilient and laugh in the face of chemo/infection/side effects!
we also watched some of the kids get their spinal taps- they just sit there, calmly and get their taps without sedation - very different than at home.
and, now we are home getting ready to have some fish made by the wonderful hilda. i asked hilda if she would come live with me at home so i could continue to eat her wondeful food. she told me i should stay here. when i told her my mom wouldn't like that much, she said - stay for 6 months, go back, say hi to momma, then come back to Tanzania. i'm still pretty sure my mom wouldn't like that.
we went to a new canteen yesterday - a sit down meal. i had rice and veggies and the ever bold nameeta had chips my eye - which is a french fry omelet! i think she really liked it. we went back today for more rice and veggies. we have become pretty tight with the guy who runs the place. besties for life, i'm sure.
we still have a few kids on the ward who we are waiting for diagnoses on.... supporting them hopefully until we can figure out how to treat them. this morning, we had an eventful moment with a little septic shock, which we managed to manage... the kid was eating chicken soup by this afternoon! these children are quite resilient and laugh in the face of chemo/infection/side effects!
we also watched some of the kids get their spinal taps- they just sit there, calmly and get their taps without sedation - very different than at home.
and, now we are home getting ready to have some fish made by the wonderful hilda. i asked hilda if she would come live with me at home so i could continue to eat her wondeful food. she told me i should stay here. when i told her my mom wouldn't like that much, she said - stay for 6 months, go back, say hi to momma, then come back to Tanzania. i'm still pretty sure my mom wouldn't like that.
Tuesday, May 14, 2013
Nameeta channels her inner Tanzania
Nameeta has embraced her inner Tanzanian and is now buying roadside snacks while we walk home from the hospital. Enjoy the photo!
how to ask for a consult
so, we are learning a bit of the systems here at the hospital... it's one thing to figure out oncology in Tanzania, it's a whole other situation to figure out how the systems work... for example, if you need a consult (like from another service such as surgery or radiation oncology or nephrology or cardiology), you write a letter in the patient's file (chart) such as:
Dear Radiotherapists,
Would you kindly consult on the patient who has rhabdomyosarcoma of the orbit. Please review the file and advise regarding treatment planning. We are greatful for your assistance in the review of this patient.
Then, the patient is seen by the consultant who returns the file with a letter in the file containing what he or she recommends:
Dear Oncologist,
Thank you for sending us your patient to review. We will set up treatment and plan to continue with radiotherapy.
They are longer than that sometimes and sometimes much shorter.
Another version is just to call them on the phone, deliver the file and the patient to their office and then wait to see what happens.
There are lots of other systems differences that we are gradually getting the hang of...
Dear Radiotherapists,
Would you kindly consult on the patient who has rhabdomyosarcoma of the orbit. Please review the file and advise regarding treatment planning. We are greatful for your assistance in the review of this patient.
Then, the patient is seen by the consultant who returns the file with a letter in the file containing what he or she recommends:
Dear Oncologist,
Thank you for sending us your patient to review. We will set up treatment and plan to continue with radiotherapy.
They are longer than that sometimes and sometimes much shorter.
Another version is just to call them on the phone, deliver the file and the patient to their office and then wait to see what happens.
There are lots of other systems differences that we are gradually getting the hang of...
Monday, May 13, 2013
dear edwin, we will never stray again...
tonight, we departed the hospital around 6pm and were happy to happen upon a bajaji on our way out of the hospital grounds. he picked us up and said he knew the road we lived on but would need some directions once we got there...we haggled for a reasonable price and hopped in to a bit of a fancy bajaji... and, then we went the wrong way out of the hospital, and the wrong way on the next road, and the wrong way on the next... all of us thinking he was going some smart back way to our house. the next thing we know, we are on this "4" lane road with people driving whatever direction they wanted, with construction going on, with about 40 people running on it, and just utter chaos. apparently, the driver decided it was too much so he took us basically over a cliff - like we were going to tip over- and then ended on a "road" that took us through a shopping-ish district. finally, he stopped to ask someone for directions and we had been heading in completely the wrong direction... i just kept saying, let's go back to the hospital and start over. but, in the end, we returned to our little home safe and sound and a little more city-wise...
(side note, edwin, is the name of our regular bajaji driver who gets us where we need to go in a timely manner- like this morning when he did some amazing maneuvering to get us to the hospital on time.)
today at the hospital, we painted the kids' fingernails. and, the mommas. they all loved it! even the boys wanted their nails painted, and they all walked around carefully avoiding touching things until the pain dried! too fun!
it was another busy crazy day- two new ones. one with a big liver and spleen that we aren't sure what's going on and another with maybe hodgkin's lymphoma. it's amazing here how kids appear on the ward. at home, we call the ER, the charge nurse, the transfer center, the attending. here, the children appear. and, then there's a mad fury to figure out what's going on and then we wait for results. the parents are the most patient people i have ever met. they wait for days or weeks to find out what's going on with their children. and, in the mean time, they laugh at our antics and form, it seems, little families amongst themselves on the ward.
(side note, edwin, is the name of our regular bajaji driver who gets us where we need to go in a timely manner- like this morning when he did some amazing maneuvering to get us to the hospital on time.)
today at the hospital, we painted the kids' fingernails. and, the mommas. they all loved it! even the boys wanted their nails painted, and they all walked around carefully avoiding touching things until the pain dried! too fun!
it was another busy crazy day- two new ones. one with a big liver and spleen that we aren't sure what's going on and another with maybe hodgkin's lymphoma. it's amazing here how kids appear on the ward. at home, we call the ER, the charge nurse, the transfer center, the attending. here, the children appear. and, then there's a mad fury to figure out what's going on and then we wait for results. the parents are the most patient people i have ever met. they wait for days or weeks to find out what's going on with their children. and, in the mean time, they laugh at our antics and form, it seems, little families amongst themselves on the ward.
Sunday, May 12, 2013
chitty chitty bang bang... the little bajaji that could
nameeta and i went to the hospital to round again this morning. we left sue at home to recover a bit from her busy last two weeks.
we had arranged for our bajaji guy (who we now know is named Edwin) to pick us up this morning at 8:30 to get to the hospital by 9... so, around 8:40, when he hadn't arrived, we decided to try our luck getting a taxi. we stood on the road with not a car in sight until suddenly the little bajaji came barrelling down kinondoni road. it was like he was racing to the finish line at the end of his hard trained for marathon, or to pick up the crazy mzungus to take them to the hospital. we threw up our hands and screamed whooo hoooo! he apologized for being late but was at church (a fair excuse, i think), and we all hopped in and off he zoomed to the hospital.
this morning, we were faced with our second in-hospital death. one of the little patients who had been hospitalized for a while with neuroblastoma and fever/neutropenia who had seemingly been getting better died overnight. her parents had left by the time we got there, but we can only imagine their grief and sadness.
we wanted to sit and talk with the mom of the newest patient with neuroblastoma, but we are going to wait for more of her family to arrive so we can decide what path to go on with his treatment.
the children were a little less busy this morning, though they were all still very interested in my glasses. i might have to leave them here when we go.
last night, we went on a shopping spree - tanzania style. we bought lots of fun souveniers to bring home with us. and, we had drinks at a lovely ocean side restaurant followed by a delicious dinner at another ocean side hotel/restaurant. it was great people watching. randomly some british guy came up to us to see where we were from, feed us a story about he was here doing philanthropic work for a rich dying 95 year old man, take our picture (on a dare from his buddies at the bar), and offer to buy us drinks. with the help of Dee's irish sauciness, we shooed him away so we could enjoy our dinner.
i keep waiting to get use to the heat... it hasn't happened yet. it's still hot.
we had arranged for our bajaji guy (who we now know is named Edwin) to pick us up this morning at 8:30 to get to the hospital by 9... so, around 8:40, when he hadn't arrived, we decided to try our luck getting a taxi. we stood on the road with not a car in sight until suddenly the little bajaji came barrelling down kinondoni road. it was like he was racing to the finish line at the end of his hard trained for marathon, or to pick up the crazy mzungus to take them to the hospital. we threw up our hands and screamed whooo hoooo! he apologized for being late but was at church (a fair excuse, i think), and we all hopped in and off he zoomed to the hospital.
this morning, we were faced with our second in-hospital death. one of the little patients who had been hospitalized for a while with neuroblastoma and fever/neutropenia who had seemingly been getting better died overnight. her parents had left by the time we got there, but we can only imagine their grief and sadness.
we wanted to sit and talk with the mom of the newest patient with neuroblastoma, but we are going to wait for more of her family to arrive so we can decide what path to go on with his treatment.
the children were a little less busy this morning, though they were all still very interested in my glasses. i might have to leave them here when we go.
last night, we went on a shopping spree - tanzania style. we bought lots of fun souveniers to bring home with us. and, we had drinks at a lovely ocean side restaurant followed by a delicious dinner at another ocean side hotel/restaurant. it was great people watching. randomly some british guy came up to us to see where we were from, feed us a story about he was here doing philanthropic work for a rich dying 95 year old man, take our picture (on a dare from his buddies at the bar), and offer to buy us drinks. with the help of Dee's irish sauciness, we shooed him away so we could enjoy our dinner.
i keep waiting to get use to the heat... it hasn't happened yet. it's still hot.
Saturday, May 11, 2013
saturday at jengo la watoto
we went in to round this morning... and we were out earlier than we would be at home - pretty impressive!
two new patients came in overnight - one with likely stage IV neuroblastoma and one with ? burkitts lymphoma. so, we went through some of their work up with the team - but will continue the work up tomorrow. nameeta and i also discussed how we treat AML back home - often with bone marrow transplant...which prompted an explanation/discussion of transplant.
the kids are becoming a little more bold in their interactions with us... chasing us and being chased, running up to us to give hugs or high-fives, playing hide and seek, charming us with toothy grins. the little girl in the picture above gives us a little dance each day... nameeta instructed her on a more advanced twist dancing technique, which she demonstrates daily quite enthusiastically. she is also obsessed with glasses and grabs mine each day, returning them reluctantly with millions of fingerprints. today, she and one of her little friends grabbed both my arms and inspected them for veins. they were pleased to find my very visible veins and pretended to place IVs. no one has central line here so they get IVs frequently - in the cannulation room - a very memorable event it seems. so, they traced each vein finding the place they wanted to insert the iv. a little play therapy perhaps went a long way.
we are home now, going to eat lunch and then off to shopping and dinner at a hotel along the Indian Ocean - so fancy!!
i wish there were snow cones.
Thursday, May 9, 2013
moja kmojo (or something like that)
good evening from tanzania!
today was a good day. mostly because at the end of the day, i got to play soccer in the hallway of the unit with about 6 of the little patients. they don't speak english, and i certainly don't speak swahili (although i make some small attempts). but, we managed to figure out the rules. we also managed to giggle and laugh (they thought this white girl in a skirt kicking the soccer ball was pretty hilarious...even funnier when i hit them in the head with the ball - it's a soft ball, don't worry). and, then a bunch of the little girls came up to us as we were getting ready to go and wanted our sunglasses. so, they put them on (upside down) and started dancing, shaking their little booties! so great! they love glasses - the other day, a little boy took my regular glasses and put them on and gave me the best grin. i will have to take a picture of him in my glasses. then, we hopped in a taxi for our ride home. sue has become quite the expert at taxi driver directing. and, at haggling with them for their fee. the best is when we get to our apartment gates, she says moja kmojo (which is not spelled right, i don't think.. but it works phenotically... and it means straight ahead or something). the taxi driver tonight was so excited to hear her speak swahili! when it was time to get out, he asked for sue's number!! it was great - he was like, ooo la la - tall mzungu who speaks english, i must get her number!! or, he just wanted to be able to give us more taxi rides... one of the two.
i thought i would just tell you all a bit what our days are like...
645AM - wake up... mostly just to the sun and to the rooster that lives somewhere near here. maybe he lives at the spanish embassy. we don't have any watches or clocks, but i keep my ipad handy so we can check it out. nameeta sleeps on the window side and wakes up first, grabs the ipad, checks the time, and gets the day rolling... by crawling out of our mosquito net.
647 - AM flip mosquito net up so it's put away for the day.
648 - AM brush teeth, apply DEET and sunscreen (dry off with cool breeze from A/C - that we only run just before bed and just as we get up), get dressed
700 AM - one of us boils water for chai, the other gets the bread from the freezer to toast, someone grabs fruit, butter and jam from the fridge and breakfast begins. we eat outside at a beautiful table made of recovered wood, with a beauitful view of the green trees and pool (although, its currently obstructed by our drying clothes).
730 AM - bajaj driver guy arrives, we hop in - first, kristina, then nameeta, then sue - this is how we sit in any vehicle because it just works best and we are off for the 1.5 mile ride that takes about 20 minutes to drive with traffic (there are some street lights but it is unclear if they mean anything). the police stop traffic if someone important is coming down the road, so we have to wait (apparently, we aren't THAT important).
8AM - arrive at the hospital, give a lecture to the medical staff of the unit (one that we prepare the night before on topics ranging from acute leukemia to lymphoma to wilms - whatever they request). we sit in this little room that is called the chemo room (i don't know why - there isn't any chemo there), and try our best to avoid bugs climbing up the chairs.
9AM - we each go to our respective locations for rounds/clinic. Sue is rounding on the ward called upendo - the more acutely ill children. Nameeta is rounding on the ward called tumaini - the kids mostly chemo. I'm going to clinic to see outpatients. But, there is typically a moment, where we open up a wound clinic accidentally and children line up to get their wounds cleaned...
1PM - break for coke hut or lunch... and, today, we braved the canteen. the med students did not get sick, so we felt safe. however, we did decide to bring our own forks... i tried to order just white rice, and the lady looked at me like i had 7 heads - as did the med student who was trying to help us order. eventually, i settled for rice and peas. we both thought it was buttery and delicious...and so far... so good.
2PM - we are doing a little chart review for the team here to see how we can help look for areas of improvement for delivery of chemotherapy, and mostly because we can do this in the air conditioned clinic.
5PM - round up Sue, take care of last minute things, high-five the kids, either walk or taxi home
we come home to delicous smelling food prepared by the wonderful Hilda. we sit around and chat and eat and then grow sleepy. We take showers at night, then prepare our lecture for the next day.
10:30PM - lights out. mosquito nets up.
one more thing... today, i had my first close encounter with a cockroach. it climbed out of a chart i was looking at, i promptly flung the chart, causing the cockroach to go flying toward a patient's mom, she and i both screamed, dr jane laughed. she told me they come toward me because i don't like them. so, then i looked at the cockroach and told him i liked him, and asked him to pass it on to all of his little friends.
today was a good day. mostly because at the end of the day, i got to play soccer in the hallway of the unit with about 6 of the little patients. they don't speak english, and i certainly don't speak swahili (although i make some small attempts). but, we managed to figure out the rules. we also managed to giggle and laugh (they thought this white girl in a skirt kicking the soccer ball was pretty hilarious...even funnier when i hit them in the head with the ball - it's a soft ball, don't worry). and, then a bunch of the little girls came up to us as we were getting ready to go and wanted our sunglasses. so, they put them on (upside down) and started dancing, shaking their little booties! so great! they love glasses - the other day, a little boy took my regular glasses and put them on and gave me the best grin. i will have to take a picture of him in my glasses. then, we hopped in a taxi for our ride home. sue has become quite the expert at taxi driver directing. and, at haggling with them for their fee. the best is when we get to our apartment gates, she says moja kmojo (which is not spelled right, i don't think.. but it works phenotically... and it means straight ahead or something). the taxi driver tonight was so excited to hear her speak swahili! when it was time to get out, he asked for sue's number!! it was great - he was like, ooo la la - tall mzungu who speaks english, i must get her number!! or, he just wanted to be able to give us more taxi rides... one of the two.
i thought i would just tell you all a bit what our days are like...
645AM - wake up... mostly just to the sun and to the rooster that lives somewhere near here. maybe he lives at the spanish embassy. we don't have any watches or clocks, but i keep my ipad handy so we can check it out. nameeta sleeps on the window side and wakes up first, grabs the ipad, checks the time, and gets the day rolling... by crawling out of our mosquito net.
647 - AM flip mosquito net up so it's put away for the day.
648 - AM brush teeth, apply DEET and sunscreen (dry off with cool breeze from A/C - that we only run just before bed and just as we get up), get dressed
700 AM - one of us boils water for chai, the other gets the bread from the freezer to toast, someone grabs fruit, butter and jam from the fridge and breakfast begins. we eat outside at a beautiful table made of recovered wood, with a beauitful view of the green trees and pool (although, its currently obstructed by our drying clothes).
730 AM - bajaj driver guy arrives, we hop in - first, kristina, then nameeta, then sue - this is how we sit in any vehicle because it just works best and we are off for the 1.5 mile ride that takes about 20 minutes to drive with traffic (there are some street lights but it is unclear if they mean anything). the police stop traffic if someone important is coming down the road, so we have to wait (apparently, we aren't THAT important).
8AM - arrive at the hospital, give a lecture to the medical staff of the unit (one that we prepare the night before on topics ranging from acute leukemia to lymphoma to wilms - whatever they request). we sit in this little room that is called the chemo room (i don't know why - there isn't any chemo there), and try our best to avoid bugs climbing up the chairs.
9AM - we each go to our respective locations for rounds/clinic. Sue is rounding on the ward called upendo - the more acutely ill children. Nameeta is rounding on the ward called tumaini - the kids mostly chemo. I'm going to clinic to see outpatients. But, there is typically a moment, where we open up a wound clinic accidentally and children line up to get their wounds cleaned...
1PM - break for coke hut or lunch... and, today, we braved the canteen. the med students did not get sick, so we felt safe. however, we did decide to bring our own forks... i tried to order just white rice, and the lady looked at me like i had 7 heads - as did the med student who was trying to help us order. eventually, i settled for rice and peas. we both thought it was buttery and delicious...and so far... so good.
2PM - we are doing a little chart review for the team here to see how we can help look for areas of improvement for delivery of chemotherapy, and mostly because we can do this in the air conditioned clinic.
5PM - round up Sue, take care of last minute things, high-five the kids, either walk or taxi home
we come home to delicous smelling food prepared by the wonderful Hilda. we sit around and chat and eat and then grow sleepy. We take showers at night, then prepare our lecture for the next day.
10:30PM - lights out. mosquito nets up.
one more thing... today, i had my first close encounter with a cockroach. it climbed out of a chart i was looking at, i promptly flung the chart, causing the cockroach to go flying toward a patient's mom, she and i both screamed, dr jane laughed. she told me they come toward me because i don't like them. so, then i looked at the cockroach and told him i liked him, and asked him to pass it on to all of his little friends.
Wednesday, May 8, 2013
Get your wounds cleaned here!
Today was Day 3 of our Tanzanian adventure at Muhimbili National Hospital! Highlights of the day included our impromptu wound clinic, our first teaching session on ALL, reviewing roadmaps and how chemotherapy is administered, and our daily canteen and coca-cola hut visit.
Kristina was changing the dressing of a patient and then suddenly a cue began. We found ourselves changing multiple chilren's wound dressings that were in need of changing until we met our match and got the nurses to help!
We were knee deep in roadmap chart review in clinic, when all of a sudden, the lights and AC went out and I screamed! We sat in silence and I was getting ready to pack up my charts, but Kristina wouldn't budge....Then it was namazing! The lights turned on and we got back to work.
I've eaten chips (or french fries) with sea salt at the canteen for the past two days. I'm getting up the courage to eat the food at the canteen which looks delicious. Kristina claims she will try the white rice. We secretly are waiting to see if the new medical students from London who tried out the canteen today get sick tomorrow. And if they don't, game on.
We have been learning a lot because of the sheer volume of patients inpatient and outpatient. Because it takes longer for the patients to reach the hospital, their disease are more advanced than we typically see. The families, patients, doctors, and nurses are so gracious, friendly, and happy. No matter what is going on, the children seem to always have a bright smile on their faces.
Tomorrow we are bringing the lovely art supplies donated by the Child Life program and the artwork our patients on 10S made. I'll shortly thereafter be opening up my Tanzanian branch of Nameeta's nail salon (similar the Camp Ukandu version).
Kristina was changing the dressing of a patient and then suddenly a cue began. We found ourselves changing multiple chilren's wound dressings that were in need of changing until we met our match and got the nurses to help!
We were knee deep in roadmap chart review in clinic, when all of a sudden, the lights and AC went out and I screamed! We sat in silence and I was getting ready to pack up my charts, but Kristina wouldn't budge....Then it was namazing! The lights turned on and we got back to work.
I've eaten chips (or french fries) with sea salt at the canteen for the past two days. I'm getting up the courage to eat the food at the canteen which looks delicious. Kristina claims she will try the white rice. We secretly are waiting to see if the new medical students from London who tried out the canteen today get sick tomorrow. And if they don't, game on.
We have been learning a lot because of the sheer volume of patients inpatient and outpatient. Because it takes longer for the patients to reach the hospital, their disease are more advanced than we typically see. The families, patients, doctors, and nurses are so gracious, friendly, and happy. No matter what is going on, the children seem to always have a bright smile on their faces.
Tomorrow we are bringing the lovely art supplies donated by the Child Life program and the artwork our patients on 10S made. I'll shortly thereafter be opening up my Tanzanian branch of Nameeta's nail salon (similar the Camp Ukandu version).
Tuesday, May 7, 2013
first report from two jet legged mzumgus (well, maybe 1 mzumgu and 1 mzumgu by association)
hello hello hello from Dar es Salaam!!
we made it! we arrived (as Sue's post said, on sunday night at around 1AM...after an eventful hour at customs and being greeted by a kind cabdriver and a whole lot of humidity).
i feel like we've been here a week already - because the equivalent of a week's worth of events happened in the last two days. and, it's hard to put it all into words. but, i'll try...(well, i will type for a while - until i can't keep my eyelids open any more).
first, it's hot. and humid. and green. and colorful. and, full of people with beautiful smiles and kind greetings (well, i assume they are kind greetings because they are said with a smile but really, i have no idea what they are saying - i just smile back).
the apartment is wonderful. it's huge! and, there's warm showers and a wonderful woman named hilda who prepares food for us. it's nice to be able to come back here after a busy day and reflect (aka almost fall asleep on the couch because of Dee's soothing voice) (Dee works for the non-profit that supports the oncology ward at the hospital. she's irish and has a great accent. and great stories).
so, the hospital. it's busy. there are so many children and their families. the kids are adorable and greet us with smiles and high-fives. they think we are silly, i think. i am still not sure exactly how many children are on the ward. and, i still don't totally get how it all works. but, they stay in the hospital for a long time, and their parents are so great and take such good care of them. there are children with leukemia, Burkitt's, hodgkins (and interestingly, young children with hodgkins), wilms tumor, rhabdomyosarcoma, and other yet to be identified things. They go to school each day. Some speak english, and some try to teach us swahili.
there are residents and interns, kind of like home. and, there are several visiting students - mostly from England. so, we start each day with a ride to the hospital. and, then we round on the one ward with the sicker patients as a big team- Sue, Nameeta, me, the residents and interns and students and nurses and nursing students and whoever else happens to be around. It's very crowded as the rooms are multi-patient rooms. much like at home, we go through the plan for the day, make sure to follow labs (although unlike at home, we get labs every 2 or 3 days), and schedule procedures and exams. then, we split up and go round on the other ward or go to clinic (there's air conditioning in clinic...very nice). we make a trip to the coke canteen (there's a whole place just to buy a coke!! amazing!), and then go back to the ward to follow up on things.
tomorrow, Nameeta and I will lead a lecture no leukemia... we'll see how it goes...
on our way home today, we walked by a school bus full of little children... and they just kept yelling mzumgu mzumgu mzumgu... they thought we were quite the site!
i'm not sure how to get pictures from the camera uploaded... that might have to wait. but, i wish all of you could see these little ones. they are just the best. and, they are so well-behaved. and, silly. today two little girls were running around in their mom's high heels. and, one little boy hit sue on the bottom! and, another little boy recited all of his animal noises.
we are having fun, trying to figure things out, and determining how we can best help. and, high-fiving little kids left and right!!
we made it! we arrived (as Sue's post said, on sunday night at around 1AM...after an eventful hour at customs and being greeted by a kind cabdriver and a whole lot of humidity).
i feel like we've been here a week already - because the equivalent of a week's worth of events happened in the last two days. and, it's hard to put it all into words. but, i'll try...(well, i will type for a while - until i can't keep my eyelids open any more).
first, it's hot. and humid. and green. and colorful. and, full of people with beautiful smiles and kind greetings (well, i assume they are kind greetings because they are said with a smile but really, i have no idea what they are saying - i just smile back).
the apartment is wonderful. it's huge! and, there's warm showers and a wonderful woman named hilda who prepares food for us. it's nice to be able to come back here after a busy day and reflect (aka almost fall asleep on the couch because of Dee's soothing voice) (Dee works for the non-profit that supports the oncology ward at the hospital. she's irish and has a great accent. and great stories).
so, the hospital. it's busy. there are so many children and their families. the kids are adorable and greet us with smiles and high-fives. they think we are silly, i think. i am still not sure exactly how many children are on the ward. and, i still don't totally get how it all works. but, they stay in the hospital for a long time, and their parents are so great and take such good care of them. there are children with leukemia, Burkitt's, hodgkins (and interestingly, young children with hodgkins), wilms tumor, rhabdomyosarcoma, and other yet to be identified things. They go to school each day. Some speak english, and some try to teach us swahili.
there are residents and interns, kind of like home. and, there are several visiting students - mostly from England. so, we start each day with a ride to the hospital. and, then we round on the one ward with the sicker patients as a big team- Sue, Nameeta, me, the residents and interns and students and nurses and nursing students and whoever else happens to be around. It's very crowded as the rooms are multi-patient rooms. much like at home, we go through the plan for the day, make sure to follow labs (although unlike at home, we get labs every 2 or 3 days), and schedule procedures and exams. then, we split up and go round on the other ward or go to clinic (there's air conditioning in clinic...very nice). we make a trip to the coke canteen (there's a whole place just to buy a coke!! amazing!), and then go back to the ward to follow up on things.
tomorrow, Nameeta and I will lead a lecture no leukemia... we'll see how it goes...
on our way home today, we walked by a school bus full of little children... and they just kept yelling mzumgu mzumgu mzumgu... they thought we were quite the site!
i'm not sure how to get pictures from the camera uploaded... that might have to wait. but, i wish all of you could see these little ones. they are just the best. and, they are so well-behaved. and, silly. today two little girls were running around in their mom's high heels. and, one little boy hit sue on the bottom! and, another little boy recited all of his animal noises.
we are having fun, trying to figure things out, and determining how we can best help. and, high-fiving little kids left and right!!
Monday, May 6, 2013
Kristeeta Arrives in Tanzania!
Hello all!
So sorry for the lack of posts. I must confess that my succes in getting the internet stick at the Vodacom shack was short lived as I couldn't use it after Thurday (ie I was getting no signal). Silly me I kept thinking the network was busy, then I thought the stick was bad but luckily Dee helped me check it and no credit was added. Minor drama. I went back to the ladies today (who remembered the mzungu lady with the crazy Oregon license) and after finally understanding that I didn't use 30 days worth of credit in 1 day they figured out that they didn't load the internet and acutally did it for me with little hassle. Whew!
So Kristeeta has taken on Tanzania! They arrived with bags heavier than the 2 of them put together but they arrived. There was a bit of high drama. I hired a taxi over the phone (always tricky to know what they understand) and he called after they landed clarifying that he was to go to the airport.
...Well, then he called about an hour later saying he couldn't find them.
...I said PLEASE wait they have to get visas.
.....He said have them call me.
........I had panic and palipitations and called him and pleaded with him not to leave as they didn't have a phone. Please wait for the Americans.
.....He said ok, I will text when I collect them.
---------2 hours and much panic later as I was about to go off in the dark to find a cab to go searching the text finally came!!! Yeah!!! (For those who don't know I was left at the airport last time with no pick-up and promised them someone would come).
...Then at 1am there they were outside with all their hundreds of pounds of luggage to haul up the stairs!
They were up and ready for action bright and early so they put in a full day at Muhimbili. Another exciting one which I will let them report on tomorrow because I think you should have their perspective. The fun and craziness continues and now there are 3 of us!! 2 very pale white doctors and 1 brown one (which confused them a lot)!
So sorry for the lack of posts. I must confess that my succes in getting the internet stick at the Vodacom shack was short lived as I couldn't use it after Thurday (ie I was getting no signal). Silly me I kept thinking the network was busy, then I thought the stick was bad but luckily Dee helped me check it and no credit was added. Minor drama. I went back to the ladies today (who remembered the mzungu lady with the crazy Oregon license) and after finally understanding that I didn't use 30 days worth of credit in 1 day they figured out that they didn't load the internet and acutally did it for me with little hassle. Whew!
So Kristeeta has taken on Tanzania! They arrived with bags heavier than the 2 of them put together but they arrived. There was a bit of high drama. I hired a taxi over the phone (always tricky to know what they understand) and he called after they landed clarifying that he was to go to the airport.
...Well, then he called about an hour later saying he couldn't find them.
...I said PLEASE wait they have to get visas.
.....He said have them call me.
........I had panic and palipitations and called him and pleaded with him not to leave as they didn't have a phone. Please wait for the Americans.
.....He said ok, I will text when I collect them.
---------2 hours and much panic later as I was about to go off in the dark to find a cab to go searching the text finally came!!! Yeah!!! (For those who don't know I was left at the airport last time with no pick-up and promised them someone would come).
...Then at 1am there they were outside with all their hundreds of pounds of luggage to haul up the stairs!
They were up and ready for action bright and early so they put in a full day at Muhimbili. Another exciting one which I will let them report on tomorrow because I think you should have their perspective. The fun and craziness continues and now there are 3 of us!! 2 very pale white doctors and 1 brown one (which confused them a lot)!
Saturday, May 4, 2013
198 pounds of glitter pens...
nameeta and i are sitting at PDX waiting for our plane... we barely made it into the airport...nameeta was nearly taken out by her monstrous bags (there was a revolving door situation...). our bags weighed in at a cumulative 198 pounds. They let my 52 pounder go... and then nameeta put on the biggest bag of all... drum roll, please - yep, it weighed in at 68 pounds. With a little explanation of what we are up to, the delta agent went back to talk to her manager (? or at least pretend to talk to someone with some pull), and came back to investigate what was really in the bag. Nameeta showed her our letter form the division head, Linda (you know, the one with the Cobras from previous blogging) saying that we were going to work with kids with cancer in Africa (definite tear jerker - and can get you out of just about anything we are hoping). And, then she had to open the bag to reveal our medical supplies. When she opened the bag, the top items were glitter pens, nail polish, construction paper, and coloring books...not so convincing of our honorable mission. Luckily there were gloves, masks, NG tubes underneath. With that, she agreed to let us go and not charge for the extra weight. And, she informed us that if you call ahead of time and say you are going to do volunteer work, they will let the extra weight slide (and they get a tax break). So, off to security we went. Nothing exciting there - just the usual hair bun squeeze from the security lady and then to the gate.
We are just headed to get some water and then board the plane. Very very exciting...
We are just headed to get some water and then board the plane. Very very exciting...
like Tina Turner, I'm just so excited!
good morning! the day is finally here! we leave for Tanzania in just a few short (long) hours. our plane leaves at 1:30 pm. i've been packed since yesterday afternoon. i've been up this morning since 5:30 am. so far, i've cleaned the kitchen and thrown out any food that could spoil, cleaned my bedroom put away my laundry, went for a run, talked to my sister, watched an episode of property brothers, and now i'm headed to the farmers market... i'm just so excited to go that i can't keep still!! it's going to be a very long plane ride... hopefully Nameeta is bringing some games to entertain me. :)
more updates to come...
more updates to come...
Friday, May 3, 2013
cold turkey
it's almost time... nameeta and i leave very soon... and, it seems that with every hour that we get closer to our departure time, we add one item to the to-do list and another item to the packing list. i made another fred meyer trip tonight, but i think i'll make one more tomorrow as i forgot a couple things tonight.
sue's updates have been making every moment of packing or getting ready seem totally worth it. i can't wait to get there and dive in to the work. although, i'm pretty sure i'll gingerly dive into it as to avoid rats and cockroaches.
on a very minor note, i was thinking about how as of saturday morning, i will stop drinking diet cherry coke cold turkey. i don't have too many indulgences (as i write this, i feel like this is something that someone with a lot of indulgences might say), but i do love diet cherry coke (and sour patch kids. i love them - those little sour and sweet gummy candies covered in sugar... delicious!). maybe i should have created a diet cherry coke wean? i suppose that i can give up diet cherry coke for a few weeks in order to help the kids. :) it's really not that much of a sacrifice. and, my dentist will be happy.
sue's updates have been making every moment of packing or getting ready seem totally worth it. i can't wait to get there and dive in to the work. although, i'm pretty sure i'll gingerly dive into it as to avoid rats and cockroaches.
on a very minor note, i was thinking about how as of saturday morning, i will stop drinking diet cherry coke cold turkey. i don't have too many indulgences (as i write this, i feel like this is something that someone with a lot of indulgences might say), but i do love diet cherry coke (and sour patch kids. i love them - those little sour and sweet gummy candies covered in sugar... delicious!). maybe i should have created a diet cherry coke wean? i suppose that i can give up diet cherry coke for a few weeks in order to help the kids. :) it's really not that much of a sacrifice. and, my dentist will be happy.
Thursday, May 2, 2013
Muhimbili Day 4
I am very proud to report that I have navigated a couple of things successfully by myself since coming to Dar.
I have ridden by myself in a bajaji--which is a little cab that is sort of like a bike taxi only it's motorized. Other names could be a tuk-tuk or rickshaw (thank you Nameeta).
I have successfully hailed a cab down twice and ridden it back to my apartment while directing the driver to the address using a combination of English and Swahili. (The English-Spanish mish mash is Spanglish, not sure what the English-Swahili mash up would be). Tonight I even argued with the driver who was going to charge me 150% of what I have paid every morning and afternoon since I've been here--which by the way is the mzungu rate (white person rate). So I said Hapana, Hapana (No, No) and we argued and I got out. I was feeling very successful until I ran up to the apartment and became convinced that he was going to get the police and come knocking at my door somehow. I was alone and my imagination got the best of me---Dee says he would have had to bribe the police to come which would be more than the $1.50 that I refused to pay. I feel better but I will haggle price before getting in from now on.
I have successfully purchased an internet modem at the Vodacom booth and bought credit while asking for the right thing and paying the correct price--not a mzungu price. And I will report that the woman pronounced Lindemulder better than anyone in the US ever does without me correcting her!
And......I successfully managed not to scream like a little girl when I large rat came running down the hall at me tonight on our ward as I was leaving Muhimbili. I do confess to muttering "Oh that's gross" several times under my breath and will make a wide swing past the door it ran into tomorrow. I'm sure it's just one of very many rats that I hope never to see again. It's friends the cockroaches really are enough.
Speaking of cockroaches, I guess that's another success. I have managed not to squirm too much when there are cockroaches crawling over the charts that I need. I think I manage to disguise the way I shake them off and I don't make a face!
So many successes.
We did have another death on the ward last night--so for everyone counting that is 3 deaths in 3 nights. They have all been very very ill so not shocking but still very sad for their families.
Things I really miss:
Not being able to talk directly to families. I find that I go back a lot to check in on kids (I know, shocking to those of you who know me) and I can't talk to the mommas and I do a lot of gesturing that I do not think they understand and pretty much make a complete fool of myself until everyone is laughing at me. I think they appreciate my effort though.
So while we may think that we spend hours talking to families at home, and we do, I think it's really hard to do this job when you can't give information. It's like having a Spanish interpreter all day long--but at least I know the Spanish interpreter is saying what I'm asking, with this I can't tell at all....
We continue to be very full, more new patients keep coming out of the woodwork. There is a new infant ALL somewhere in the hospital that we are trying to locate. 4 months old, not really sure what we are going to do with that but we'll see. They are telling me she is in an intensive care unit somewhere and I'm not sure why but she will come over when stable. I'm not sure she can stabilize until we start treatment but that's a task for tomorrow.
We also located the other child who flew in from Shirati 2 days ago. She is 13 years old and got sent to the women's gynecology ward because of suspected germ cell tumor. So needless to say AYA oncology would be an even more difficult concept here! She is coming over to us tonight. as well.
Nameeta and Kristina are doing a great job gathering everything that I keep adding to their lists so I hope they have room for clothes but I can't wait for them to arrive because we need a few more hands and everyone is very excited to have them to teach!
Good night from Dar!
I have ridden by myself in a bajaji--which is a little cab that is sort of like a bike taxi only it's motorized. Other names could be a tuk-tuk or rickshaw (thank you Nameeta).
I have successfully hailed a cab down twice and ridden it back to my apartment while directing the driver to the address using a combination of English and Swahili. (The English-Spanish mish mash is Spanglish, not sure what the English-Swahili mash up would be). Tonight I even argued with the driver who was going to charge me 150% of what I have paid every morning and afternoon since I've been here--which by the way is the mzungu rate (white person rate). So I said Hapana, Hapana (No, No) and we argued and I got out. I was feeling very successful until I ran up to the apartment and became convinced that he was going to get the police and come knocking at my door somehow. I was alone and my imagination got the best of me---Dee says he would have had to bribe the police to come which would be more than the $1.50 that I refused to pay. I feel better but I will haggle price before getting in from now on.
I have successfully purchased an internet modem at the Vodacom booth and bought credit while asking for the right thing and paying the correct price--not a mzungu price. And I will report that the woman pronounced Lindemulder better than anyone in the US ever does without me correcting her!
And......I successfully managed not to scream like a little girl when I large rat came running down the hall at me tonight on our ward as I was leaving Muhimbili. I do confess to muttering "Oh that's gross" several times under my breath and will make a wide swing past the door it ran into tomorrow. I'm sure it's just one of very many rats that I hope never to see again. It's friends the cockroaches really are enough.
Speaking of cockroaches, I guess that's another success. I have managed not to squirm too much when there are cockroaches crawling over the charts that I need. I think I manage to disguise the way I shake them off and I don't make a face!
So many successes.
We did have another death on the ward last night--so for everyone counting that is 3 deaths in 3 nights. They have all been very very ill so not shocking but still very sad for their families.
Things I really miss:
Not being able to talk directly to families. I find that I go back a lot to check in on kids (I know, shocking to those of you who know me) and I can't talk to the mommas and I do a lot of gesturing that I do not think they understand and pretty much make a complete fool of myself until everyone is laughing at me. I think they appreciate my effort though.
So while we may think that we spend hours talking to families at home, and we do, I think it's really hard to do this job when you can't give information. It's like having a Spanish interpreter all day long--but at least I know the Spanish interpreter is saying what I'm asking, with this I can't tell at all....
We continue to be very full, more new patients keep coming out of the woodwork. There is a new infant ALL somewhere in the hospital that we are trying to locate. 4 months old, not really sure what we are going to do with that but we'll see. They are telling me she is in an intensive care unit somewhere and I'm not sure why but she will come over when stable. I'm not sure she can stabilize until we start treatment but that's a task for tomorrow.
We also located the other child who flew in from Shirati 2 days ago. She is 13 years old and got sent to the women's gynecology ward because of suspected germ cell tumor. So needless to say AYA oncology would be an even more difficult concept here! She is coming over to us tonight. as well.
Nameeta and Kristina are doing a great job gathering everything that I keep adding to their lists so I hope they have room for clothes but I can't wait for them to arrive because we need a few more hands and everyone is very excited to have them to teach!
Good night from Dar!
Wednesday, May 1, 2013
Muhimbili
So, a lot has changed since I was here last time. The kids are now at Muhimbili hospital and not at Ocean Road. The ward is larger and there have been some advances but there's still a very long way to go. I can see how they are missing Trish here right now but they are doing the best they can and are very appreciative we are here.
The ward is split into 2 parts: Upendo and Tumaini. Upendo is for the sicker kids and Tumaini appears to be for the kids that are less ill or between chemo. I have spent my first 3 days here in Upendo so I will talk about that.
There are 4 rooms and there are between 3 and 8 kids in the various rooms. So far this week (for the medical colleagues out there):
- There have been 2 new ALLs confirmed and starting chemo. And today a child with a white blood cell count of 100,000 arrived on the ward from another ward.
- 2 new AMLs (one of whom died after the decision was made not to treat)
- 1 new Hodgkin's with a huge neck mass and huge mediastinal mass--pathology is not confirmed but we're treating toward the most common thing.
- Things in question: A child with a jaw mass which is not Burkitt's on pathology and there is a concern it's arising from the parotid gland? A child with a huge chest wall tumor that the pathology called myxoid liposarcoma but we're not sure we believe that so the pathology is in Ireland. A child who came from another hospital after empiric treatment for Burkitt's with an abdominal mass that didn't change so maybe a Wilm's tumor.
- There's a new non-Hodgkin's lymphoma--again a Burkitt's that didn't respond. I'm trying to figure out if they mean diffuse large B cell or lymphoblastic lymphoma right now.
- A couple of rhabdomyosarcoma presumed diagnoses.
- And a child with neuroblastoma that today started having bloody stools after a cycle of chemo who is not looking well.
- Another child with recurrent neuroblastoma literally with new tumors growing before our eyes.
We've had 2 deaths in 2 days so that's not a good track record. Hoping things will start looking up.
Today I found myself in the first room writing chemo for the child with a new AML diagnosis, for which we are very picky about air filtering and infection control at home.... and I find myself looking at the walls covered in cockroaches and the child covered by flies....and I think to myself.......are we too picky about the air filtering? Probably not, but I need to reassure myself somehow that this might be ok.
And I find that hand hygiene is not really something that can be practiced here. There is no soap by the sinks (maybe Kristina and Nameeta can fit that in :) and there isn't really hand sanitizer. There are bottles but I think they contain spirits. For all of you doing your maintenance of certification out there for the board of pediatrics....maybe I should do my quality hand hygiene project here!
Kids aren't really getting chemo correctly right now. There is a lot of stopping induction chemo for leukemia due to low counts which we are working on education about. Also, lots of holding chemo for fever.....and holding for a week......
I think there are some very simple things that can help and we will definitely work on that!! Like some sort of roadmap!! And some education and systems things.....there is so much to do I'm finding myself overwhelmed. I never thought I would solve the world's problems in one month but now I hope we can just do a little.
Oh, and the last interesting tale to tell....yesterday (yes on Day 2) they brought me a baby from the general peds ward with a gigantic mass over her buttocks--and it really was huge. Pathology is hemangioma twice and hemanagioma on ultrasound so we'll go with that. Thanks to my friendly neighborhood Hematology consultant, Dr. Mike Recht, for the help. If I can find her again we'll start some steroids!
So that is a little peek into what things are like on Day 3 here (which by the way is a national holiday here so I was mostly here with myself and the 2 German students and some nurses today). Two Tanzanian doctors did come for part of the day but they were mostly down in the clinic. But we're making it work.
Thanks to everyone who has donated to fill our suitcases!! And keep the thoughts coming!
Sue
The ward is split into 2 parts: Upendo and Tumaini. Upendo is for the sicker kids and Tumaini appears to be for the kids that are less ill or between chemo. I have spent my first 3 days here in Upendo so I will talk about that.
There are 4 rooms and there are between 3 and 8 kids in the various rooms. So far this week (for the medical colleagues out there):
- There have been 2 new ALLs confirmed and starting chemo. And today a child with a white blood cell count of 100,000 arrived on the ward from another ward.
- 2 new AMLs (one of whom died after the decision was made not to treat)
- 1 new Hodgkin's with a huge neck mass and huge mediastinal mass--pathology is not confirmed but we're treating toward the most common thing.
- Things in question: A child with a jaw mass which is not Burkitt's on pathology and there is a concern it's arising from the parotid gland? A child with a huge chest wall tumor that the pathology called myxoid liposarcoma but we're not sure we believe that so the pathology is in Ireland. A child who came from another hospital after empiric treatment for Burkitt's with an abdominal mass that didn't change so maybe a Wilm's tumor.
- There's a new non-Hodgkin's lymphoma--again a Burkitt's that didn't respond. I'm trying to figure out if they mean diffuse large B cell or lymphoblastic lymphoma right now.
- A couple of rhabdomyosarcoma presumed diagnoses.
- And a child with neuroblastoma that today started having bloody stools after a cycle of chemo who is not looking well.
- Another child with recurrent neuroblastoma literally with new tumors growing before our eyes.
We've had 2 deaths in 2 days so that's not a good track record. Hoping things will start looking up.
Today I found myself in the first room writing chemo for the child with a new AML diagnosis, for which we are very picky about air filtering and infection control at home.... and I find myself looking at the walls covered in cockroaches and the child covered by flies....and I think to myself.......are we too picky about the air filtering? Probably not, but I need to reassure myself somehow that this might be ok.
And I find that hand hygiene is not really something that can be practiced here. There is no soap by the sinks (maybe Kristina and Nameeta can fit that in :) and there isn't really hand sanitizer. There are bottles but I think they contain spirits. For all of you doing your maintenance of certification out there for the board of pediatrics....maybe I should do my quality hand hygiene project here!
Kids aren't really getting chemo correctly right now. There is a lot of stopping induction chemo for leukemia due to low counts which we are working on education about. Also, lots of holding chemo for fever.....and holding for a week......
I think there are some very simple things that can help and we will definitely work on that!! Like some sort of roadmap!! And some education and systems things.....there is so much to do I'm finding myself overwhelmed. I never thought I would solve the world's problems in one month but now I hope we can just do a little.
Oh, and the last interesting tale to tell....yesterday (yes on Day 2) they brought me a baby from the general peds ward with a gigantic mass over her buttocks--and it really was huge. Pathology is hemangioma twice and hemanagioma on ultrasound so we'll go with that. Thanks to my friendly neighborhood Hematology consultant, Dr. Mike Recht, for the help. If I can find her again we'll start some steroids!
So that is a little peek into what things are like on Day 3 here (which by the way is a national holiday here so I was mostly here with myself and the 2 German students and some nurses today). Two Tanzanian doctors did come for part of the day but they were mostly down in the clinic. But we're making it work.
Thanks to everyone who has donated to fill our suitcases!! And keep the thoughts coming!
Sue
Trip to Dar
Hi everyone! Sorry for the delay in posting, it has taken awhile to work out internet (and still working on it).
So, the trip to Dar was very uneventful but VERY LONG! The whole issue of only one stop over is really great except you sit down for a VERY long time on those 2 flights. My only issue is that the guy in front of me on the Amsterdam to Dar let insisted on having his seat in FULL recline the whole way (even in the quick stopover in Kilimanjaro) and for those of us with long legs that makes the flight pretty uncomfortable!
PS. Kristina and Nameeta--no need to download movies for the flight--each flight had a selection of a ton of movies for your viewing pleasure!
Then came the Dar airport and the VISA process which is quite interesting. There is this guy that takes your passport and maybe asks you what type of visa you want and maybe you can have a discussion with him (or not). Then he scrutinizes your hundred dollar bills and if they are dated before the late 2000s he rejects them as "no good." Lucky for me I had enough "good" ones because I thought it was going to be $100 and it was $300--surprise!
Then you wait.....and wait......and wait......and wait in a herd of people all hoping their name will be called by this guy behind the desk and a window who makes a little attempt to call your name. I was the second to the last called--story of my life. But by then the rest of the airport was deserted so I walked through the passport checkpoint (no one in the booth) and picked up my bags (2 of the 4 left) and walked past customs (no one sitting there) and out the door--where the BEST thing happened! There was a man with a sign with my name on it!!! For those of you who don't know, the last time I was here no one picked me up and I had no where to go!
Then I met Dee, our Irish sponsor and was at the apartment which is very very nice. Successful trip!
And Kristina was right--the 97 lbs of my checked luggage and the 35-40 lbs on my back all made it here safe and sound! After unpacking, I was reminded that I don't have much by way of clothes so the bags will be very light on the way back!
So, the trip to Dar was very uneventful but VERY LONG! The whole issue of only one stop over is really great except you sit down for a VERY long time on those 2 flights. My only issue is that the guy in front of me on the Amsterdam to Dar let insisted on having his seat in FULL recline the whole way (even in the quick stopover in Kilimanjaro) and for those of us with long legs that makes the flight pretty uncomfortable!
PS. Kristina and Nameeta--no need to download movies for the flight--each flight had a selection of a ton of movies for your viewing pleasure!
Then came the Dar airport and the VISA process which is quite interesting. There is this guy that takes your passport and maybe asks you what type of visa you want and maybe you can have a discussion with him (or not). Then he scrutinizes your hundred dollar bills and if they are dated before the late 2000s he rejects them as "no good." Lucky for me I had enough "good" ones because I thought it was going to be $100 and it was $300--surprise!
Then you wait.....and wait......and wait......and wait in a herd of people all hoping their name will be called by this guy behind the desk and a window who makes a little attempt to call your name. I was the second to the last called--story of my life. But by then the rest of the airport was deserted so I walked through the passport checkpoint (no one in the booth) and picked up my bags (2 of the 4 left) and walked past customs (no one sitting there) and out the door--where the BEST thing happened! There was a man with a sign with my name on it!!! For those of you who don't know, the last time I was here no one picked me up and I had no where to go!
Then I met Dee, our Irish sponsor and was at the apartment which is very very nice. Successful trip!
And Kristina was right--the 97 lbs of my checked luggage and the 35-40 lbs on my back all made it here safe and sound! After unpacking, I was reminded that I don't have much by way of clothes so the bags will be very light on the way back!
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