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