Bits and Pieces

I went to the duka (store) the other day, and Dr. Makanza was there. Actually, he's there a lot lately, as he owns the store and his regular employee is gone. So the surgeon runs the store. He's probably the most overqualified shopkeeper in the world, but he says that Africans must do many jobs to survive. 

Dr. Makanza, surgeon and shopkeeper

Docs here aren't paid much, not by our standards anyway. They make about 900,000 tsh/month. Roughly 600 USD. Great by village standards surely, the average villager makes maybe 20 USD/month. Still, only one doctor has a car.  I digress.

I went to the duka to get some cookies, they have about 3 varieties, none of which are OREOs. When I got there Dr M was closing up early, because he had 2 C Sections to do. He said twende (let's go), and off we went. He invites me to most of his surgeries and is happy for me to tell you all about them. I've described a surgery in an earlier letter, but I am revisiting the topic because this is the third C Section I've observed and while all the moms are fine, only one  baby has survived.

The baby born a few weeks ago was stillborn, and had been dead for a while, so there was no attempt to resuscitate. The first baby born last Saturday was a nice size, perfectly formed, but not breathing. The cord had no pulse, and was compressed in the middle. So Habili, (nurse anesthetist) began helping the maternity nurse with compressions and bagging. 


Unfortunately, the maternity nurse was unfamiliar with infant resuscitation technique, and he had to teach her on the spot.They worked on the baby for about 10 minutes, but then the Dr. M needed him, so I gloved and helped with the babe. We got him breathing, but it was a weak effort, and he went off to the maternity floor.

I asked what else could be done for him, and they said nothing, either he would live or he wouldn't. The doc gave him a 50/50 chance. He died the next day, which was no surprise considering there was no respiratory support available after we got him breathing. Dr. M said that generally, in situations like these, they focus on saving the mom. She needs to live because there's usually too many people already depending on her, and everything falls apart if she doesn't survive.

The second baby born that evening wasn't breathing either, and one of the skinniest newborns I've seen in a while. Habili was still busy, so I helped the other nurse. We got him breathing, he even cried a little. He went to the floor, and is doing well. When I saw Habili the next day he updated me on the two babies. 


Habili's a good guy, he's also the man who drove me around on the pikipiki a few weeks ago. Like the doc said, you need more than one job here. We were talking and he said that the babies would not have died had they been born in a hospital with 1. adequate staffing 2. adequately trained staff 3. machines to support the babes and 4. better access to prenatal care. I had to agree.

It bothers me that I have so easily accepted these deaths. I worked at Kaiser in Oregon for many years, and every now and then there would be a stillbirth, or a SIDS baby would be brought in from home, and it seemed everyone in this big hospital heard about it and was affected. You could feel it in the air. People were sad.

In America it's just not as common to lose a babe or a mom, but it's different here. I don't like to think that I've become hardened, maybe I've just gotten used to it. Maybe I just focus on other things.

Please don't take what I say as criticism of the hospital and staff, I'm just repeating what was told to me by the doc and the nurse anesthetist. I think, given the circumstances here, and the lack of almost everything, they do a good job. The hospital has come a long way, and things have improved over the last few years. There's a nursing school now, and they just opened a high risk maternity waiting house. The high risk center should by a huge help, as many moms arrive too late or have taken local medicine which can do more harm than good. Also, some volunteers have arrived with new equipment. Statistics are looking better.

Another huge problem is transport to the hospital. There is no actual ambulance. There are pikipikis here to bring people in, but that costs money, and if you're coming from a far away village, even more. So people try the local medicine and/or wait till the patient is almost dead to hire transport. It's not uncommon for laboring mothers to have to stop the pikipiki and deliver by the roadside. Hemorrhaging moms, ruptured uteruses, all sorts of emergencies arrive on the back of a motorcycle, over a very rough road.

It would be wonderful to get used equipment from other countries. Certainly drug companies send all their unpopular drugs here, hence my ready supply of rohypnol (date rape drug) for sleep. First World hospitals update equipment regularly, (there must be warehouses full of useful crap somewhere). One problem is that even if equipment is sent, it might get held up at customs. Custom agents can and will demand huge bribes to release the crates, and most people can't or won't pay. Or would pay but don't have the money. Then the agent assesses a fine for storage. You can't win.

For a while when I worked at Kaiser, I was allowed to collect unusable supplies. When a patient dies or is discharged from the hospital, all the unused supplies (sterile, unopened dressings, unused IV bags) can't be taken from one patient's room and used for another patient, so are discarded. For a few years I was able to collect these supplies and bring them here. Then one year I was told the supplies would now be sold to these same countries. Unfortunately, what is sold frequently doesn't get to it's intended destination. See above.

I won't belabor the point, maybe I already have, but in essence, they aren't asking for your new stuff, just the stuff you throw out. Dr. Makanza is hoping that someone who reads this might be in a position to help out. He's a very good guy, and he lets me run a tab at his duka.
I can't think of a clever segue from infant mortality to my safari so I won't try.

I went on a small safari the other day with my friend Ruth, the wife of the hospital director. She was taking her son back to boarding school, and she invited me along. The drive involved passing through Mikumi National Park, where all the animals live. Ruth's brother-in-law has a car, and said he'd be happy to stop for animal pictures. And stop he did, again and again.

These guys are all along the road

We piled into his van at about 6 am and had such a good time. I've been through Mikumi about 10 times on a bus, and it's impossible to get good pictures, but on this day we drove slowly and looked for animals.  As it's been raining, and it's cooler, the animals are out. I prefer to get out of the car, you get better pictures. Sometimes I walk the road for a bit, a fact which was not lost on Samweli, who told me to stay away from the elephants. But I knew that.
Anyway, it was wonderful. 

Twiga

We had tea at the Kilimanjaro Inn, a very pretty place with the worst service in the free world.  Don't ever go there.We were speculating as to why the waitress was so sour. We figured maybe she a) had malaria, or b) her husband left her. She was too young for c) menopause. Whatever it was, she was a migraine of a woman and so mean it was funny. 

Pundamilia

We ate lunch at another place and it was very nice. I had the ugali and goat. I've been promising myself that I'd try ugali again, and now I don't have to do it anymore. It's the local lump of starch and that's what it tastes like. The goat was great. I like the ribs best.

Tembo

On the road to Mikumi  vendors will festoon the trees with 

baskets and mats. Too lovely

John has arrived. He got here yesterday and is busy painting. Asante Mungu because I've about reached the limits of my expertise, such as it is. It's good to be working with him again. He's truly wonderful, just stands there and paints, you can sit there and watch everything emerge. It takes me about 2 days to paint an animal, and John has totally finished the background in one. Folks stop by to watch. It's a relief to have him.

saw this chameleon on the way to school the other day

We have ringworm, by "we" I mean half the kids at the chekechea. I noticed it on Susie the other day, and in anticipation of its rapid and inevitable spread throughout the ranks, I got some ointment for my first aid kit at school. Not much in the kit, bandaids, antibiotic cream and some nail clippers for mani-pedi day. We have classes on Friday till break then Martha plays games with the kids while I trim their incredibly dirty nails. 


As promised in the First Aid books, the ringworm is spreading about as quickly as it can, so I went to the lab and got some of the camera film containers they use for urine and stool samples and put ointment inside and gave them to the kid's moms. All will be well. Not to worry, I used clean film canisters.

One day Im going to write a book on all the stuff Africans put on a bicycle.

Once I saw flats of eggs stacked like this, 4 feet high. Amazing

Still hammering away at the R and L issue, as well as thirty, forty, sixteen ( or sikisteen), thirteen and fourteen. Samweli has no top or bottom front teeth so when I demonstrate where to put his tongue he spits all over me. Good kid that he is, he turns his head, so now I can't see where he's putting his tongue.  Asante Mungu this is usually the worst problem I have. 


Life is good. Nakupenda