Tanzania Week 1

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I arrived in Tanzania after a dastardly lay over in Addis Ababa, Ethiopia. I was only supposed to be there for 4 hours which would have been 4 hours too many. It was by far the worst airport I have ever been in, there were like 2 “cafes” that literally had almost no food. I bought 2 apples (which cost me $4) and I think that about cleaned them out. They had a couple of fair trade stores but if you don’t want truffles or cigarettes that store is useless. I got there about 5:00 am and hadn’t slept much on my flight from Tel Aviv so I found a couple of chairs and curled up and fell asleep for a couple of hours. I found my gate a little before boarding time and there was a huge line waiting to board. I didn’t really know what we were waiting for but I got in the line with everyone else. As I got closer I started seeing people freaking out and yelling at the people at the desk but I couldn’t understand anything they were saying. When it was finally my turn I found out what all the fuss was about… they had downgraded the plane to a smaller vessel so the flight was grossly overbooked. They took the last 40 people or so who had booked and kicked them off the flight. They were telling us that we would have to be on the next flight which wasn’t until the next morning. Needless to say everyone was in a uproar, a lot of people were climbing Kilimanjaro that day or the next day so if they missed that flight they would miss their climb and their entire reason for going to Tanzania. Everyone was arguing and demanding seats and it was just a joke. A lot of people were in a group with several people so I just quietly asked one of the girls if they had any seats since it was just me. She told me she would try and it was seriously an undercover mission to get me on that flight. When she came back we had to casually walk away from the crowd, she slipped me the ticket and that was it. I think I would have been mauled if the others had seen me get a seat. At this point the flight had been delayed about 4 hours but eventually we took off.

            My flight to Tanzania was uneventful until we were about to land when I heard everyone calling for medical. A guy a few rows behind me was unresponsive and vomiting and looked like he was seizing. Another nurse from the states was on the flight so we just got him some oxygen, kept his airway open… the basics. He kept coming to and then passing out again and he was super diaphoretic and incoherent. By this time we had landed and everyone was getting off the plane. They had an ambulance waiting so I figured he was probably okay. I got through passport control and everything without incident and my volunteer program coordinator was there to pick me up, which was a relief since my flight was about 4 hours late. I got to the volunteer house and met the other volunteers, had dinner, and went to bed!

            My placement is an Tengeru hospital which is a district hospital about 20 minutes away from the volunteer house. I just finished up my first week of volunteering and it has been an experience to say the least. The first day we met with the matron of the hospital and she put me and Jo, another volunteer from the UK who just finished med school in the male ward. We had no idea what to expect or what we would be doing. We got there and say around for about 3 hours waiting for the doctor to arrive so we could round on the patients. The conditions in the ward are really terrible. There are two patients to a bed, there is no glass in the windows, everything is filthy… it was really bad. We made our way around to each patient very very slowly. The doctor would ask them a question or two, then sit and talk and laugh with the nurse for 15 minutes, maybe write a referral or a prescription and we would move on. She was asking Jo and I for all of the treatments and medication dosages and would just prescribe whatever we said. I could have said anything in the world and it would go down as scripture. It’s amazing the confidence they put in us just because we are white.

            Tuesday, we did our best to avoid the ward and we ended up in the outpatient clinic. We were each put with a doctor and we just saw patient after patient. We saw a lot of people with Malaria, TB and Typhoid. We saw a couple of patients who had been assaulted and a little boy (well like 13 or 14) that had been raped by his uncle. I guess his dad didn’t know whether or not to believe his story so he asked me whether or not I thought he was telling the truth because he thought I was the most qualified to decide. If I said I thought the little boy was lying he probably would have gotten the crap beat out of him and if I said I thought he was telling the truth he probably would have killed the uncle. Not an awkward position at all… The doctor I was with kept asking me for money to help him get to America and asked if I would buy him an iPhone. Um, no.

            Wednesday we were in the HIV/AIDS clinic and we saw patients all day long who were there for their monthly check ups. It was interesting and I learned quite a bit. We were in the clinic when one of the other volunteers came and grabbed us to look at an x-ray. There was a little boy, maybe 4 or 5 who had broken his arm and the doctor wanted to just pop it back into place. I’m no orthopedist but even I could tell that it was surgical. The bone were completely misaligned and broken away from the joint. We ran over to minor theater before the doctor started manipulating this poor kids arm. They hadn’t given him any pain medication and he was just sitting there shaking. We told the doctor he needed to go to a bigger hospital for surgery and not to try and relocate it. I finally got a look at his arm and it was huge! So swollen and tight and I was concerned he could have compartment syndrome. I wrote a prescription for some pain medication (totally in my scope right?) and told his dad to take him to the hospital in Arusha right away. Hopefully he was able to get surgery because he could have lost all function in his arm, the swelling was so bad. While all of this was going on there was another lady who had miscarried so they had done a D and C earlier in the afternoon. Kyle, one of the other volunteers said she had lost a ton of blood and they weren’t doing anything for her. After we got the little boy squared away they came to take her to the female ward. They threw her in a wheelchair (literally) and she went unresponsive. Awesome. She started sweating profusely and her pulse was really thready and weak. I asked if we could give her some fluid and the doctor said no because she needed blood (…? Obviously this is so backwards, she needed volume in whatever form she could get it) so I hung another liter anyway. She came to a little bit and they took her over to the ward. Jo and I followed her over and when we got there she was laying on the bed with a sheet over her head. Everything here is so relaxed, they were just moseying about while this lady was trying to die. Jo and I put in another IV, hung more fluid and gave her some medication. By the time we left her pressures were 100/60 and HR in the 80’s. Success.

            Thursday was operating day. Everything here is so lax, Jo and I just walked into the OR and went back and forth between surgeries all morning. There is almost no concept of a sterile field, they wear flip flops in the OR (they made us take off our tennis shoes to put on flip flops),  they hardly clean the OR’s between patients, and the nurses and anesthesiologist just wander back and forth between the OR’s with patients open on both tables. They don’t monitor any vital signs, and they don’t really use anesthetic. We saw a couple of c-sections which was fun, and an appendectomy. One of the lady’s had huge fibroids on her uterus, a couple of them were literally bigger that a baseball. The surgeon just ripped them out and rearranged her entire abdominal cavity and the patient was awake and moaning in pain the entire time. It was wild.

            Friday we spent the day in minor theater. It was relatively uneventful, we did some dressing, put on and took off some casts, removed some stitches…. This is where I’ll be spending the majority of my time so I should get some good hands on patient care!