March 10, 2016 – The Clinic That Wasn’t….

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We had decided in advance that if it had rained all night we would cancel our final mobile clinic at Upper Kitete as the drive had been so treacherous the day prior. We all had lots of busy work to complete and a free day at FAME to catch up would have been well used by each of us. It had rained some last evening during my birthday party, but overnight it cleared and the roads would be no problem so it was decided that the mobile clinic was on for the day.

Thursday mornings there are nursing educational lectures and Jackie had decided to speak about the bedside assessment and treatment of seizures. This would be an excellent talk for the nurses who are most often the first line for assessing events such as seizures and are also the ones to initiate treatment so it is very necessary that they have these skills. Everyone was very engrossed in the topic which was readily apparent in the questions that were asked during and following the session.

Jackie teaching the nurses about bedside recognition of seizrures.

Jackie teaching the nurses about bedside recognition of seizrures.

We arrived to Upper Kitete by late morning and were immediately confronted by the obvious lack of patients waiting for us. In the past we would arrive to large groups of patients milling around the building and we would be ready for a busy day at the clinic. It’s difficult to tell what the reason is for this change in volume and whether it has to do with missing the clinic last October due to the election or whether it could be related to the rains that have been falling. Sokoine has visited this area on numerous occasions to announce our clinic and that has been sufficient in the past. We had talked about doing only one day each at Kambi ya Simba and Upper Kitete while also scouting out sites for additional neurology clinics and I think it is probably the right time for that. I will likely try to get away for an afternoon next week so we can visit additional sites.

We waited for an over an hour to see if patients would show, but to no avail so decided to head to the overlook for a picnic lunch. As the villages we go to have very limited services such as a market or restaurant to get lunch, we have been stopping on our way out of town to buy an assortment of Tanzanian “take-out.” This includes delicious beef samosas, mandazi (something like a donut or muffin) and vitumbua (I’m not sure if that’s the correct spelling, but they are a deep fried, sweet rice cake). And, of course, the always necessary Fanta drinks. Fanta passion is my favorite here, but there is also Stoney Tangawiezi, which is a very strong ginger ale. We sat at the overlook having lunch for a bit, but then realized there were very dark and ominous clouds looming in the distance and in the direction of our travel. We quickly packed everything up, jumped in the Land Cruiser and began to head back to the main road, glancing back briefly as we passed the clinic to assure ourselves there weren’t any patients waiting for us and were on our way. Shortly after leaving Upper Kitete, though, we ran into a massive rain storm with tons of runoff already flooding the countryside. The runoff was flooding large sections of road and the drainage ditches were all full. As we came to Kambi ya Simba, which is about halfway back to Karatu, though, the rain suddenly stopped as we passed through the storm and the roads were clear. It was as if someone had just turned off the faucet. The rest of the drive back to Karatu was uneventful and we arrived at FAME unscathed from our brush with the flooding.

Unloading the radiology equipment

Unloading the radiology equipment

FAME was having some exciting times after we arrived in that the X-ray equipment that had been donated by GE had arrived after a day delay. This was a huge event as it has been in the planning stage now for probably over a year and the radiology building has been finished for some time. The technical aspects of this project have been overwhelming, but Nancy Allard, FAME’s ICU nurse/architect, has been overseeing things and has been doing an amazing job. The big news for the neuro team, of course, is that the radiology suite is going to include a new 16-slice CT scanner! Up until now, we have had to send all of our CT scans to Arusha, which is 2-1/2 hours away and that’s if the patient can afford the $200+ for the study. Having the ability to do our own CT scans will be revolutionary for us, but with that comes the issue of doing a CT scan just because it’s there and over utilizing the scanner. That all still needs to get worked out and I am planning to make up some algorithms that will help when deciding who needs a CT scan when there are neurological indications.

Pulling the one ton + CT scan out of the truck

Pulling the one ton + CT scan out of the truck

The CT scanner on the flatbed

The CT scanner on the flatbed

Lowering the CT scan

Lowering the CT scan

The CT scanner after still wrapped

The CT scanner after still wrapped

Our first look at the CT scanner

Our first look at the CT scanner

Moving the CT into the radiology suite

Moving the CT into the radiology suite

Positioning the CT scanner

Positioning the CT scanner

In any event, all of the radiology equipment showed up in a large box truck that included the CT scan weighing in at over a ton and everything was boxed with “no tilt” and “no impact” warning labels that would register “red” if any of the pieces were mishandled. They were all meant to be unloaded with a forklift, but there wasn’t one in working order anywhere in Karatu, so they finally found a small crane to use. With some amazing maneuvering and a bit of “Tetris” work, they were able to unload everything, including the CT scanner, and just in time as it began to rain a bit and they needed to get everything inside or undercover so as not to damage the electronics. Finally, everything was moved to its respective resting place and the work of the GE engineers could begin in earnest. One big problem will be the energy requirement for the equipment to operate – though FAME is now attached to “the grid” and has moved on from relying solely on solar power to function, the current generator here is not capable of powering the radiology equipment here during the very frequent power outages that have been plaguing the country. And that’s just one of the many logistical problems that needs to be solved prior to the radiology suite being fully operational. I believe it will only be a matter of time for all of these issues to get worked out and hopefully for our next trip in October we will have access to our own CT scanner that will be just shy of a miracle considering all the hurdles that have been overcome to get to where things are today.

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