June 12-16th Last week in Ifakara

Pics are shots from the vehicle on the road to Lupiro, trying to
depict typical rural living in Tanzania.

My last week in Ifakara was a nice continuation of what was a
valuable learning experience in the hospital and a further exposure to
the rich Tanzanian rural culture. Clinically, I spent the week with
surgery, paediatrics and internal medicine: doing rounds with the
interns and physicians and attending clinical meetings in the
mornings. Things really slow down here in the afternoons and most of
our afternoons were free to relax or explore the city and the city's
fine establishments for a cold one after work with the interns. I'll
just relate a few particularly telling anecdotes about my experiences
this week.

Surgeries were still cancelled due to a complete lack of
anesthetic drugs. Even emergency C-sections were only receiving
minimal anesthetics, so it was a slow week in surgery and a sad week
to be doing rounds and surgical clinics, having to tell people to
maybe come back in a week or two for a better chance to be treated.
Even sadder when those surgeries that had to be done immediately were
done without anesthetic. I didn't see this personally, but a boy with
40% burns to his body had to undergo surgical debridement (removal of
dead tissue) without even a pain killer. It's hard to believe what can
and will be done when you don't have any other options. However,
perhaps the hardest moral issue I've been faced with has been related
to the cost of medicine here. Everything in the hospital costs money
and must be paid for before receipt of service. This even applies to
the burn patient in ICU mentioned above, who was not receiving any
antibiotics despite septic wounds simply because he could not afford
it. Even a child with a sever complication of diabetes (ketoacidosis)
could not be monitored closely with electrolyte levels because each
electrolyte cost 5$, a price too high for her family. This just
screams "wrong" at me on so many levels that I had a hard time not
pulling out my wallet and paying for the meds or tests myself.

Despite not participating in the theatres for the week, I did
enjoy doing rounds for multiple days and starting to know the patients
and the cases. I felt like I was legitimately able to contribute to
the care of the patients, and felt like my opinions were valued and
respected. As an example, it didn't seem as if many people in the
hospital felt comfortable reading EKGs, so I was able to spend a few
minutes going over the basics with some of the interns in peds. It
felt nice to help out, even in a minor way.

I guess to summarize my experience at St. Francis: I saw that a
resource starved hospital is doing all that it can for its patients,
sometimes against odds that are stacked heavily against them. The
level of care and the nature of the patient-doctor relationship are
markedly different between our country and theirs. I hope that in the
coming years these physicians will not only continue to make
technological advances, but also advances in how patients are treated
once they walk through the doors.

On Wednesday afternoon we managed to take a field trip to Lupiro
Health clinic, and smaller clinic with 20 inpatient beds and 3 staff
physicians. Susan had been there 4 years ago with her group and said
that it was worthwhile seeing a smaller facility. (I actually tracked
down her name in the guestbook they had there! It was a great feeling
to recognize her handwriting and have a little piece of my wife
sitting there in that book, half way around the world.) Lupiro didn't
have many patients when we arrived, but we could see that it has been
well-used for many years. The buildings are all pretty dilapidated and
certainly not a place that would promote healing. There are water
stains in the ceilings and large portions that are just missing
roofing altogether. The beds look uncomfortable, but not necessarily
cramped. There are even dividers between many of the beds, a step up
from muhimbili or St. Francis! The physician in charge graciously
showed us around and explained some of the difficulties he faced. He
also showed us the medication store room, which unfortunately was a
bit of a stretch for all the empty shelves that were inside. We
decided to donate some money and some of our clinical things to Lupiro
once we finished our clinical experience in the hopes that even little
bits would help.

On Friday we went to see the hippos on the river, but alas, the river
was too swollen and the hippos were nowhere to be seen, favouring
smaller rivers where vegetation is presumably easier to get at. We
wanted to go along for the ride anyway, and it turned out to be a
great trip in an old school, 40 year old dug out canoe. We spent an
hour and a half on the river and saw many species of river bird,
including stork, herron, pelican, skimmers, bee-eaters, eagles etc… it
was a nice and relaxing end to the week. Unfortunately I didn't get
any pictures for fear of losing my camera in the green and greasy
Kilombero river.

Kinda sad to say goodbye to Ifakara… It was just starting to feel
like we were settling in nicely. However, we're all excited to be done
the program proper and moving onto to our own separate adventures. I'm
off to Rwanda!! 5 others are going to be climbing Mt. Kilimanjero and
one will be heading to Zanibar.