Escargot?

I had to work the OPD (outpatient department) today because my coworker unexpectedly announced that he has meetings this entire week in Masasi (neighboring region) for the secondary school here. There is something fishy about this sudden revelation....

I don't particulary like working in the OPD because all patients are seen here (sort of a triage spot) - everything from orthopedics to peds/medicine, etc. and I don't particulary gain any experience in triaging ortho cases. So I send all of the male patients that are not straightforward to the theatre for the gen. surgeon to give a final disposition. I think I saw 50-60 patients. They are sometimes quick triage visits othertimes a full exam. The toughest part is trying to pretend I understannd the entire history in Kiswahili......I still believe that the people in southern Tanzania speak with an accent that is difficult to understand - sort of like southernerns in the states? I did not think I would get a break from the continuous stream of patients; however, I stepped out around noon for some tea and bagia (fried okra I think) and peanuts. I was back in the OPD until 2:30.

At 2:30 we had a meeting to discuss the 2nd maternal death of the year. This death was in a 28 year old mother about 23 weeks pregnant with HIV who was admitted with palpitations, fevers, and dyspnea. She died about 4 days after her admission. The CD4 count was 354, which is generally above the level at which ART is started. I found out about her death while I was on call on Saturday right after leaving the theatre for splenectomy in a 8 year old boy who fell down from a mango tree. (When there is an emergency trauma case, the gen. surgeon gets called and then i assist). I saw another kid up in a tree as we were taking this boy to the theatre. Don't know if he made it down safely or not.

BTW the first maternal death was a transfer with postpartum sepsis, severe malaria and severe anemia after delivering IUFD (intrauterine fetal demise) at an another hospital. She was only about 22 years old but had multiorgan failure. Very sad case.

Aside from the splenectomy, Saturday's call was relatively quiet. I was hoping to be in Mtwara for a weekend free, but was not given permission by the gen. surgeon because I was told I had the previous weekend free and we are supposed to only have one weekend a month free. Don't ask me how my colleague can unexpectedly get a week off to go to a meeting in Masasi but I could not switch calls to get a weekend free.

Anyone like escargot? Referring to the picture above. I have to explain. When I'm on call I have to hope that I don't get called to see patients around 6:30 becuase that is when dinner is served in the Abbey guest house. Murphy's Law was the case this past weekend. Twenty minutes beforfe dinner, I got a call from the male surgical ward to see two patients - a ruptured spleen and a ? inguinal hernia. So of course I was running to see the patients so that I could make it to dinner on time when I stepped on my slow-moving friend above - a crack of the shell and a pile of yellow sludge later, I was down in Ward 2. It seems that its snail season nowadays with snails/slugs all over the place. Add some garlic butter and chicken broth and call it escargot? Actually I would have preferred to scoop up the pile of sludge and cook to add some variety to my meals because lately my diet has consisted of mystery meat, tomatoes and rice.

If you sense a cynical tone in this post, I think you are right, I do too. Its because I'm still frustrated by my banking issue. Its now been 2 months since I deposited my predeparture check from VSO but still hasn't cleared. I say "hi" to my "friends" in the bank almost every day to ask if my check has cleared. "Bado" they say = "not yet" I was expecting this response again today so I refused to leave the bank until they gave me the telephone number of the boss in charge. I have emailed Canada to ask them too. Hopefully somehow the check will turn up and clear. Right below good food and family/friends I think efficiency of banking systems ranks #3 on my list of things I miss from the US :)

Miso Soup

Just back from dinner. Was invited to Irina's house for a Japanese dinner. Irina is a JICA (Japanese International Cooperation Agency) Volunteer based in Ndanda working at a secondary school teaching chemistry. Along with the other VSO volunteers, we met up with Irina and Mickey another JICA, IT volunteer to eat Japanese food - fried rice, miso soup and meat with potatoes. Chocolate cake and a sort of pineapple jello dessert. Tanzanian beers served for beverage. V. Good meal.
I was on call on Thursday night (valentine's day). It was relatively quiet. There was one call from the male surgical ward around 6 pm to see a pt with a "Mamba" bite.....I read the chart and saw "mamba" bite, looked at the patient with a huge gaping wound in the posterior thigh and then soon enough learned that Mamba is Kiswahili for crocodile. Needless to say it was the first crocodile bite i've seen. Forget about management. Just brought the patient to the theatre for wound cleaning. A few smaller lesions could be sutured. I gave pain meds and antibiotics. Was not expecting to be looking at the posterior thigh muscles again after gross anatomy first year of med school. The young kid was swimming in the local river and came with severe pain and bleeding of his thigh after a crocodile bit him. Apparently it was not even the first "mamba" bite of the year.
The rest of the call was quiet except one patient returned, a readmission for post menopausal bleeding. Biopsy last month came back as cervical squamous cell carcinoma. She is at least a stage III with pelvic side wall involvement. She needs radiation so she is referred to Ocean Road hospital in Dar Es Salaam for further management.
This weekened is my free weekend. The plan was to go to Mtwara for R&R and snorkeling but found out about 15 minutes into the drive that the guest house was already fully occupied. We had to turn around and head back to Ndanda. I was a little disappointed but at least we found out soon after we departed. Maybe next week I can switch a call and make it to Mtwara.
That is it from here. Hope you have a good weekend.

Weekend

It rained most of the day yesterday. We got a brief downpour and then a steady light mist....its cooled things off, so its not as humid.
I was on call yesterday. Early start with a repeat c-section (prior c-section x2 in labor).
Around noon, I had another case of trauma to the head with a scalp laceration that needed suturing.
The rain picked up by mid afternoon. I thought would keep patients away.....got a call from male surgical ward to see a 21 year old who fell off his bicycle while riding downhill. Apparently lost control because of the slippery road and fell on his knee. He had a compound distal femur fracture, that required emergency traction/repositioning. I called the general surgeon; Emergency turned into a wait of about an hour before the "theatre" nurse arrived with the key to open the doors to the OR. At least I was home by 10 and ready to call it a night.
Read a little bit - "The famished road" - very interesting read by an African author, Ben Okri - surreal fictional story of a boy living in between a world of reality and spirits. I fell asleep reading only to be woken up by ward 6 calling to see a woman who came in after a physical assault by her husband with bruises to her eyes, and pain and swelling in the ribs. She's admitted for safety, pain control and for xrays to rule out fractures today. And I'm not sure what the policy is regarding reporting domestic violence. Back home and switched the lights off only to get another call about 15 minutes later again from the female surgical ward to see a woman who came in after falling down in her house. She smelled heavily of alcohol and had minor bruises to her arm. Disposition - to home with brufen, avoiding further alcohol.
The rain stopped by this morning, leaving overcast skies, and a cooler temperature. I had a scheduled repeat c-section this morning, followed by laparotomy for pelvic mass that revealed a pyosalpinx, peritonitis and appendicitis. The outpatient department was relatively quiet, so I was back home by 3.
I stopped by the bank to see if my check had cleared after depositing a predeparture allowance from VSO back in December. "Bado" I'm told (meaning not yet). At first I was getting angry and frustrated by how slow the bank and postal service operates but by now I think I've become a little more patient. We were taught by our Kiswahili teachers in Morogoro "TIT" meaning This is Tanzania - an accronym that they (Tanzanian's) use when service is slow!

Dinner

Ndanda's entire expat community (aside from the members of the Benedictine church) met again for dinner tonite. The four of us sat outside the back of our houses and ate dinner - meat, gnocchi, salad and tomato soup, with a lemon cake for dessert..... Very good meal. Topics of discussion - current events - politics (US and international),....The events leading up to Super Tuesday is getting a lot of attention among the Tanzanian's.....One lab assistant asked today "Do you think Mama Clinton will win the election?" Last night while eating dinner at the guest house I over heard some Tanzanian's asking each other "do you think America is ready for a woman president?"
And re the violence in Kenya....seems that hopefully things have quieted down a little bit for now. I had never realized how "tribal" the country is and has been for a while. I heard one of the doctors working in Mtwara say that in Kenya even now, some doctors of one tribe may refuse to treat patients from another tribe....
Super bowl Sunday tomorrow - I had almost forgotten about it; do the Giants have a chance?
I don't know what the spread is but seems like New England is heavily favored? Correct me if I'm wrong.
I'm on call again tonight. I switched calls w/ my colleage because he had to go to the neighboring village for a meeting today; On call again tomorrow. Its been quiet so far ("Knock on wood").....
Going to try to sleep now while its quiet. Have a good weekend!