It is hump day here at FAME, though I really don’t think it has the same connotation here in Tanzania given that our schedule is a bit hap hazard. In the past, with the four-week rotation, we had a bit more freedom to fit everything in, though it does seem to have worked out reasonably well given the one less week for each team and now having twice as many teams (rotations) throughout the year. We’ll be working six days in clinic this week and taking our first Sunday off to go on a game drive to Ngorongoro Crater, a World Heritage Site and something not to be missed here if at all possible. Next week will be our mobile clinic week in which we will be going on the road for three days to visit more remote villages within the district and see patients in each of those locations. Next weekend will be our two-night Serengeti trip in which we leave on Friday morning and return on Sunday evening. Visiting Oldupai (or Olduvai) Gorge and Shifting Sands along the way to the entrance gate, we’ll get a game drive in on Friday afternoon, all day Saturday, and then Sunday morning, making the trek back on Sunday afternoon and visiting Kitashu’s boma on our return trip. The final week will be clinic everyday here at FAME, allowing us to see a few patients back for quick follow up visits in case we needed to re-evaluate them. This group will depart on Saturday, October 7, and the next group will arrive the following morning, October 8. It gives me a bit of a “ground hog” sense in that I will essentially repeat the entire schedule again including the Crater and the Serengeti, though our mobile clinics will be to different sites.
The full morning report, meaning doctors, nurses, and pharmacists, now occurs on Monday, Wednesday, and Friday. This is new for FAME and has been a huge success as we have the nurses present the patients, which is no small task, and then everyone discusses the medical and/or surgical aspects of the case. This includes the medical ward, surgical ward, and the maternity ward which includes the neonatal patients. Getting all of this done in the allotted thirty minutes can be a bit of a challenge, but this system seems to be working the best and it has remained after its initial institution. One problem, though, is that the conference room isn’t large enough for everyone to fit meaning that not all of us are able to attend. This morning, Whitney offered to be at the meeting and get whatever information she could on the inpatients who we were following as well as whatever new patients had come in and needed to be seen by us. This is most often pretty obvious, but there are times where you just can’t quite hear what is being said, so it’s essential that you stay on your toes and pay attention. Thankfully, the doctors here are not shy about asking for our help, so we will usually hear about a consult shortly after we start in clinic.
With four total residents here for this rotation, it does give us some freedom to have three teams seeing outpatients at any one time (with me staffing them) and then one resident who can float and see consults if there are any, and, if not, they can double up with one of the other residents in the outpatient clinic. Thankfully, we have more than enough translators to work with the residents as well as Dr. Anne, who is just coming back from maternity leave so is only working the afternoons at the moment. Again, the translators, other than Nuru, who is a pharmacy tech, are clinical officers and so are clinicians that can participate in the patient’s care as opposed to just translate for us. In this manner, we can not only evaluate our patients, most of who do not speak a word of English and sometimes not even Swahili, but also train the clinicians that we are working with and leave something behind after we’re gone.
I spend much of the day communicating with my friend, Leonard, in Arusha, regarding the stretch Land Rover that had needed some repairs while I was gone, but as is often the case, things don’t start getting worked on until just prior to my return. Couple this with the state of the power grid in Tanzania, which calling it suboptimal would be generous, and the fact that frequent brown outs are the norm now and constantly interrupting the ability to make the necessary repairs, the vehicle was not ready for me to take to Arusha. For this reason, I had driven our standard (non-safari equipped) Land Rover here, which was a bit of a tight fit for the five of us with all our luggage and required that I leave the refractometer that I had carried all the way from home in Arusha to come with the stretch vehicle. The word on the stretch was that it would be here tomorrow, which was a good thing as we would need it for our Sunday drive into the crater.
Of course, little did I know, but Sehewa, our nurse anesthetist/optometrist, has planned on taking photos with the refractometer as it has been donated and he wanted to send these to the donors. He would be leaving for the US on Friday for an educational opportunity at Stanford University, which they were sponsoring, so we needed to get the refractometer here sooner than later to take the photos. Hopefully, it and the stretch would be arriving tomorrow, fingers crossed.
Meanwhile, our clinic was once again quite busy as soon as we opened at 8:30 am. My head cold was little improved, though I had decided (or perhaps others had decided for me) to take a COVID test to make sure that it wasn’t anything more worrisome. This has happened to me before where I was sure what I had was a run of the mill cold, but just to be safe, I’d take a test to appease everyone else which I guess is the more considerate thing to do. The test was, of course, negative such that I’ve continued my streak of dodging bullets as I’ve not had COVID before, or at least not that I’ve been aware of. Despite having flown to West Africa in February 2020, then to Tanzania at the beginning of March 2020 (without masks, of course), and then scrambled home with the threat of the border closings only to have them fly us into NYC, and finally traveling back to Tanzania in October 2020, by myself and before vaccinations, I have somehow avoided contracting this nasty bug. I’m sure that most of you now think that I’ve jinxed myself, and even though I am more on the superstitious spectrum than not, I’ve recognized that there are just some things one cannot control.
Our young girl with the acute cerebellar syndrome, or at least that was our leading diagnosis at the time, was still unsteady, but was no worse than she had been yesterday. As her family lives very close to FAME, it was decided that we would discharge her home without rescanning her and have her come back in two weeks to re-evaluate her. Though her story wasn’t bad for an acute cerebellar syndrome, her exam really wasn’t as she had unilateral nystagmus. Trust me, this is all from Whitney and Dan Licht (on WhatsApp) as I would really know much about it though I have seen a few cases in my career.
Our clinic once again seemed to drag on into the afternoon and we were there far later than normal. As we were about to walk home, I received a text from a friend that one of their friend’s one year old had fallen from a low height and struck their head on the tile floor. Unfortunately, I would have to ask Whitney to see the child with me given their age, but we’d walk home first and then return after they had registered the patient which would allow us enough time to relax for just a moment. We headed back a short while later to evaluate the child, who turned out to be just fine, and we were back to the house in no time. Had the child needed a CT scan, that would have been another story as they would have had to be sedated, similar to the infant that needed to be scanned on Monday night and couldn’t be sedated on a full stomach.
In the three days we’ve been here, it’s been fairly busy, and this is always better than being bored I say. I think between the waning pandemic (at least for here), the increasing volume in general with the loss of some nearby government services, we are beginning to see a pickup in volume beyond the pre-pandemic levels which is always a good thing as it allows us to do more teaching with the clinicians here and for us to gait yet more experience.