July 5th and 6th - Ruraler medicine

Pic 1 - Off to tour the hospital
Pic 2 - An amusing but sad room in the pediatric hospital
Pic 3 - "Mosquito village"

On Monday morning, we had an introductory session with Dr.
Pemba, the director of the institute that we'll call home for the next
two weeks. He had a brief presentation about the training center, the
research institute and the hospital that form a triumvirate of health
care and research in Ifakara. Dr. Pemba seems like a great man, with a
great vision for his institute. He has been a very generous host and
incredibly excited about the partnership between Ifakara and
Dalhousie. He speaks like a proud father about the journey this
institute has gone on since the 70s. After his presentation, we spent
some time touring the hospital and research institute.
The hospital has 370 beds, with all major departments represented
(except mental health, which I don't think gets serious consideration
here). The wards are modest, but each person has their own bed (in
contrast to Muhimbili) and each bed has a mosquito net. The buildings
of the hospital are all linked by covered walkways, which are
typically lined by people waiting to see the doctor. We get a lot of
stares as we walk by, but a few smiles too. An old woman, barely
taller than my navel, wearing massive coke bottle glasses and walking
with a cane a foot taller than her, was so excited to see us and shook
our hands with such abandon that I was worried she'd fall over from
the vibration. It was pretty cute.
Apparently we're coming at a quiet time for the hospital
because many people are currently out in the field harvesting their
crops, or maybe planting their crops; I'm not all that clear on
growing season here. In any case, apparently if faced with the
prospect of harvest and a serious medical problem, people here
typically choose harvest. It's tough to think about how many adults
and children are dying out in the fields as they try to put food in
their bellies.
The research institute here has some great facilities, including
great lab space for molecular biology, immunology, serology,
microbiology etc… They are used by a number of different
investigators, who come to Ifakara to study tropical medicine. We got
a tour of the facilities and then the staff entomologist took us into
the mosquito tents, which are used to breed laboratory strains of
mosquitoes. They have even created a small village within a big mesh
tent, which they use to study mosquito behaviour in a semi-natural
environment. The goal here is to gain a better understanding of the
vector that carries Malaria, the killer of so many in this and other
African countries.
On Tuesday we were in the operating theatre again, although there was
definitely a difference between the national hospital and this site.
There are only 2 ORs and they alternate days for procedures:
Obstetrics and Gynecology on Tues/ Thurs; General surg and Orthopedics
on Mon/Wed/Fri. I got to see the fastest C-sections imaginable (knife
to baby = 1 minute) and another giant ovarian tumour resection.
Anesthesia here is different as well… they don't have anesthetic
machines, so they use the old style bellow ventilator for general
anesthesia, with the old-style draw-over aerosolizer for halothane
delivery. It's all a little technical I know… suffice to say that they
are using old equipment and old drugs, if they even have the drugs at
all. A couple surgeries were postponed because they ran out of
ketamine. (The other night a lady almost died of cerebral malaria
because the hospital ran out of saline! The nurse had to go around the
wards sucking of saline from other people's IV bottles.)
In the afternoons this week and next, we'll be taking part in a
course that the Ifakara institute has piloted here a couple years ago
on childhood illness from tropical disease. The idea is to train every
health care provider, from medical officers in rural areas to
physicians in tertiary centers, how to recognize serious childhood
illness and take steps to refer or treat the child as appropriate. It
is an attempt to standardize care and prevent really sick children
from falling through the cracks in the health care system. It should
be an interesting perspective on home-grown solutions to health care
problems here in Tanzania.
Side note: We found a canteen that serves a massive plate of rice,
meat, beans, fruit and greens for 2000 shillingi (1.50$) for lunch and
dinner. Jackpot. I'm so glad that I like rice, because it is the
definition of a staple food here. Also, we've discovered that 500mL of
beer is about a dollar. It seems criminal.