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!