Karosho

Call night on Sunday was not too bad. I had one c-section for CPD. The mother was a G6P5 (5 children - all born by normal vaginal delivery). But this baby did not want to deliver - suspected asynclitism. The night was quiet after that. Only a couple of patients before. Got called around 10am to pronounce the death of a man in the male surgical ward. 63 year old s/p motorcycle accident.
Today it was not too busy, apparently December is a light month for surgeries and deliveries, I guess partly because many patients don't have the money this time of year and just don't deliver now. Almost all of the patients rely on their farming of cashew nuts (karosho) to earn a living. One of the nurses asked me to buy some, so I bought a bag for $5,000 schillings (a little less than $5). They taste pretty good, very fresh.
Yesterday, I was post call. After morning conference went to round on the patients in maternity. Then one patient sent to W8 for evaluation. First trimester pain and a little bleeding. Tried to take her by wheelchair to the theatre to do an ultrasound but en route her head fell backwards and eyes shut, so we rushed back to W8, took vitals, placed a line and did a bedside ultrasound there. Was pretty confident by the exam/ultrasound she had an ectopic pregnancy. Went to OR for laparotomy and found ruptured ectopic (two this week). Again ~ one liter of blood in the pelvis...
One of the volunteers working in Mtwara is here visiting for a few days. She is from the Phillipines and is a lab tech, actually has a masters in blood transfusion services (?). She is working in a gov't hospital in Mtwara - where staff, support, supplies are not as good as Ndanda. She is leaving to go back home early (in April). Just came to visit the lab here. We had dinner last night with her, Mr. Piet the hospital administrator and two of the volunteers here - Sheena and Diane. Gnochi, and salad, one of the first good meals I've had in a long time. I asked Sheena for the recipe, maybe I can add some variety to my meals.
Received the first package from the states the other day - what an ordeal. I went to the post office about half a dozen times because they are very specific about documentation. First the package had not arrived, and when it finally did, I needed to get a key from the hospital warehouse and an "authority card" from the hospital administrator..... The post office was reluctant to give me my package, but I insisted that I have received authority and work for the hospital and need to get back to my duties......(it took about 3 weeks to arrive - about a week to get to Tanzania and then about two weeks from Dar Es Salaam).
Hope everyone is doing well at home. Remember you can visit me in Tanzania whenever you want......except for August - Ellen is getting married! Scary to write let alone think about (Congratulations David and Ellen).
Another couple of weeks in Ndanda before my 10 day holiday in Dar and then Zanzibar - which I'm definitely looking forward to....