Miscellaneous

 2-06-2012

Just had a really nice warm shower.  Yes, warm!  The students (Laura B and Serena) ingeniously filled bottles with water and set them outside in the sun.  Nice holes in the cap served as a great showerhead (thanks to Carl).  We have been having intermittent water.  We assume that is due to the construction of the nursing dormitory, currently going at breakneck speed to finish in time for the nursing school to start.  Part of the time during the day, there is plenty of water pressure.  But by shower time in the morning, there is no pressure.  So nearly half the time, we have been dipping water to “shower” and flush.  Cold water.  Even when we have good water pressure, so you perhaps can imagine the luxury of a warm shower. 

Another invention was a corkscrew from a clothes hanger.  Someone borrowed and did not return our corkscrew and we were not successful in pumping in air with a syringe or grasping the partly protruding cork with my trusty Leatherman.  I managed to push it further down.  So Laura said, “If we only had a clothes hanger, we could make a corkscrew….”  Meg said, “I have a hanger!”  Carl manufactured a fantastic functional corkscrew.  And I enjoyed the wine.  Well, several of us enjoyed the wine.

Someone suggested Post It notes and masking tape for a schedule.  Water bottles have been used for exercise weights (not by me).  I used duct tape for my bed net. 

There are probably more innovations, but I cannot think of more.

My little Optoma projector has worked pretty well for a couple movies.  We were all depressed by “Ides of March,” but “Bridesmaids” the next night took care of that.  We intended to only watch half, but we couldn’t stop.  It’s hardly enough for daytime use.  It simply isn’t strong enough light and we cannot cover the windows adequately.  We will need to find a bigger projector to use next year, one that stays here.  It seems likely that the Nursing School will need one for teaching too.

And we continue to see interesting cases, of course.  Today, a child was admitted with “Renal failure” because of swelling.  I looked it up and in the US we would see 2 – 7 cases per 100,000 children annually.  The Clinical Officers here are often under pressure with a ton of patients.  On rounds a little later, we examined the child closely and found some telltale signs of malnutrition, including the swelling.  The MUAC (mid upper arm circumference) confirmed profound muscle wasting.  Her belly was distended and the ankles swollen.  Her hair was fine, like lanugo or baby hair, another sign of malnutrition.  We started the Plumpy’Nut.

But the Nutrition Project has been slow overall.  The Medical Director of the hospital was gone all last week and I have not gotten the chance to review the overall plan with him and things must be sanctioned.  It really is a formality, but necessary. Today I will speak to Mama Saga, Dr. Saga’s wife and the hospital Matron (or head nurse) about the project.  We will need heavy buy-in from the nurses to succeed.  We have Meg who is a grant writer helping at least informally for the funding grant we may try to get, but if anyone wants to do some grant work, PLEASE let me know.

We have had the benefit of our pharmacy students to help with drugs and bacterial coverage, which the Tanzanian doctors appreciate as well.  We have been seeing a number of pneumonias and other infections.  The students have been giving great talks after morning report.

Another interesting case today is a seven year-old, quite small, malnourished, but also with enlarged lymph nodes at the neck and many other places.  Is this extra-pulmonary TB, lymphoma or infection?  Almost certainly there is underlying HIV, but we will find out tomorrow, when the tests are back.  There has been an expansion of tests available, but still profoundly limited and we reamin unsure of what is actually available.

Hot water!

We have a couple mobile clinics to go on this week, then off to Ruaha for two days of R&R before we head home.

The students are all collecting great cases for their (mandatory) presentations at home.  They also have been stellar on their presentations here, generating many thoughtful questions.  They are a real credit to all of us!   they will be great doctors.

(They better be.  They will be caring for us in a few years!)