Farewell Lindi, TZ and final blog:(

I said goodbye to my colleagues and friends of the hospital last night at my 'farewell party'. Hosted by the Doctor-in-charge and coordinated by one of the head Maternity nurses and medical staff, the party was held at one of the hotels on the beach. About forty people turned out to help me say goodbye.
Speeches were made, followed by drinks and food, and then a little bit of dancing to end the night.
Up on stage with the Doctor-in-charge and Regional Administrative Secretary.



Our local DJ on the job.


Cheers to everyone

Dancing at the end of the night!
Tomorrow I'm flying north to Kilimanjaro for the start of my safari in the Serengetti!

Hospital Pictures

This is our Maternity Ward. There are about 14 beds and usually about 20-30 patients in the ward! Maybe you can see in the back of the ward, most of the beds are shared by two, sometimes three patients! We are lucky to have received brand new beds with mosquito nets from Mama Salma Kikwete, the first Lady of Tanzania, who recently came to Lindi to donate beds and equipment. Its a full ward round day, meaning we see and examine all of the patients in Maternity Department. Farther back in the ward, through the double doors is "Labor and Delivery" where patients are brought for triage and for delivery. There are 3 delivery "beds". In our hospital we are doing on average about 140 deliveries per month so those 3 delivery beds are usually always full!



This young girl is 16. She just delivered twins by cesarian section. I think she is actually lucky. There are so many teenage girls who come very late to the hospital or get referred from a dispensary after having been in labor for 2 to 3 days. They often end up with an IUFD (Intrauterine Fetal Demise) and unfortunately a VVF (Vesicovaginal fistula). While this girl managed to deliver healthy twins, she will need alot of social support being only 16 and a new mother!



Here you see our "sterile speculums" and other "sterile equipment". The equipment has in fact been "sterilized" in an autoclave but certainly you would not be able to guess by the look of these! Our patients don't complain nor do they even seem to notice!


I only have 7 days left in Lindi. A lot of mixed emotions! There are many things I'll miss and many I will be happy to leave behind. In fact I only have 5 working days left, but who is counting!

What I'm really going to miss most is the people I've met here in Africa - some very extraordinarily genuine people. There is one particular author, Kuki Gallmann, who describes Africans as "People for whom tradition is important and to whom family values still matter; people who protect the young and respect the old, care for the sick and feed the hungry, even if it means sharing the little that they have; generous people, ready to smile and to forgive; people with a song in their heart and a dance in their step; enduring, compassionate and infintely patient." (From the novel 'African Nights'). I think this is a very accurate description.

Remembering Chitanda

Chitanda was one of the two x-ray technicians working in the hospital. He died early this morning in the hospital due to severe Malaria and pneumonia.

Chitanda was probably in his mid fifties and had worked at the hospital for over twenty years! Since I started work in September I saw him every day working as usual. He was an integral part of the x-ray department! I come to x-ray to scan patients for ultrasound and perform HSG's (Hysterosalpingograms) - a study used to evaluate patients with infertility and other gynecologic disorders. I could always tell if the HSG showed some significant finding by the look on Chitanda's face when he came out of the developing room with the film. If there was a smile on his face, the patient either had some evidence of tubal disease or a uterine filling defect. If his face was expressionless, the study was probably normal:)

I spent much of the day today in the x-ray department and I couldn't help but spend most my time feeling sorry for Chitanda's family and for his long time friend and co-worker, Juma, who like Chitanda has worked in the x-ray department for over twenty years, and spent almost everyday working together with his friend and co-worker.

Chitanda was admitted to the hospital with Malaria last week, then discharged home after about five to seven days of treatment; then he was re-admitted a few days ago. His condition deteriorated and he passed away this morning. I stopped by his room in the hospital to check on him and give him my condolensces last week, and was expecting he would bounce back in no time! But unfortunately he did not make it.

Chitanda's funeral service will be tomorrow morning. I am really hoping to attend, but these days a number of the clinical officers are away from the hospital and as we're short staffed already, I'm afraid I'm probably going to be spending the day in the hospital and clinic.

My condolensces to all of Chitanda's family and friends who will be at the funeral tomorrow!

The patients

There are some patients I meet that I will remember for a long time. Their names will escape me but their stories I'll remember. Sometimes the patients who make lasting impressions on me have good outcomes with happy endings but more often than not the patients who I remember are the sad cases with very unfortunate outcomes.
I met the patient above in the ultrasound room today. She is a 60 year old woman who came with increasing abdominal pain and early satiety. By the looks of her abdomen you would think she's about to deliver! But unfortunately this patient has an advanced stage cancer probably of ovarian origin. The ultrasound showed a ton of ascites and a large pelvic mass. I wanted to admit this patient to the gyn ward for exploratory laparotomy for diagnostic/therapeutic purposes, but the patient declined. Her relative explained that her family has no money and can't afford an operation. I told her that she would have to pay Tsh 6,000 (about $6 US dollars). She said she has to go home first to collect her belongings and discuss with her other relatives. I had to agree with her plan and I let her go home. (Unfortunately) I am not allowed to waive the fee for surgery or personally help patients pay for surgery. I'm sure the financial issue was one of the reasons for presenting to the hospital at such a late stage!!

Here we are preparing a patient for a cesarian section.

This young girl is only 22. She has a full term pregnancy, one previous cesarian section (when she was 16 years old) and she is HIV +. She came to the hospital alone, without any relatives! Although she does say that she has a husband, he wasn't around. The cesarian section went well but she had a ton of adhesions in the abdomen/pelvis. The baby had good apgars but we won't know if the baby is HIV+ for another couple of weeks.

I took this picture in the operating "theatre" just before the cesarian section. I'm lucky to use this operating theatre which was just constructed last year and opened about a couple of months ago. There is plenty of space and much better light source compared to the small, dark, operating theatre we had been temporarily using when I arrived in September!!

Miss Lindi 2009

The Miss Lindi 2009 Beauty Pageant was held last night at the Oceanic Hotel. Hundreds of people turned out to see 10 girls compete for the right to become 'Miss Lindi 2009'. The pageant consisted of a short dance intro by all of the girls, followed by rounds of swim wear, an evening gown display, talent show, and final round question to be answered by the finalists. After all of the rounds were finished contestant number 4 (above) won. She seemed to be the favorite from the start and had the most number of fans cheering for her in the crowd.

The event was surprisingly well organized and was held at the nicest venue in Lindi, The Hotel Oceanic. Sponsored by Vodacom, one of the largest telecom companies in Tanzania, there were a few short speaches made by managers of the company as well as members of Lindi District preceding the comencement of the event.

Once the opening speaches and introductions were over, the 10 girls came out and danced for a little while and then went back stage to prepare for round number 1 - swimwear (my personal favorite:).

The next round, evening wear was also enjoyable. The third round, talent, was a much shorter round than the rest because only four or five girls decided to put on a show of talent which consisted of either singing or dancing.

The contestants were narrowed down to the top five and each of the finalists was asked the same question by the judges, "What would you do to help development in the district of Lindi if you are selected to become Miss Lindi 2009?" The winner had a well organized answer consisting of addressing different sectors - education, health and as well, hoping for support from the Tanzanian government. Her answer was given in Kiswahili so my translation may be slightly off!

It was a good night. I sat in the front row of the "will call" general seating directly behind the VIP area so I had a clear shot at the stage. Entrance fee was $5 for general admission, $20 for VIP, which included a dinner buffet. On my salary here, $5 is alot! So I opted for general seating!

That's all I have for you for now. Until next time......

Mama Kikwete

The First Lady of Tanzania, Mama Salma Kikwete, wife of President Kikwete, came to Lindi Sokoine Hospital today to visit the new Maternity Ward and to donate new beds and new equipment to be used in the Maternity Ward.
When Mama Kikwete arrived, she headed straight to the maternity ward to see the new equipment and beds which had already arrived a few days prior. Before entering the ward, she passed by all of the doctors working in Maternity, including myself. She offered a greeting to each of the doctors in Kiswahili, however, to me, she said "how are you?". I said "safi" or great! It was the only exchange I had with Mama Kikwete.

After she passed through the ward, she returned to the podium where a few brief speaches were made by the Doctor In Charge and Regional Medical Officer, followed by a speach by Mama Kikwete. After her speach, she left the podium to cut a ribbon around two of the new beds donated to the hospital.

There really was alot of local support, as Mama Kikwete is from Lindi and I'm told she was actually born in Sokoine Hospital!

Fishing

I went fishing on Sunday. Here I am with two local fisherman aboard their handmade wooden boat. We set out about 8 in the morning into Lindi Bay heading due east toward the Indian Ocean. We first headed out a bit north to pick up our bait which consisted of "daga" or little fish. We set out further into the bay, made one stop along a remote beach to pick up some logs in order to build a small roof for the boat to protect us from the blazing heat of the sun. We set out further into the bay and started fishing.

We caught six or seven small fish - bluefish, redsnapper, "changu", two fish called the "double beard" fish or in Kiswahili is called Mchuichui, or something like that. There were 3 local fisherman, myself and one German development worker whom I recently met in the town.

It was just a nice day to be out in the bay! I personally didn't catch any fish but I was there to take pictures and offer my encouragement and moral support. Go to my facebook page to see the rest of the pictures from my fishing excursion.

Swine Flu and other hogwash

Swine Flu is spreading like pork buns in a dim sum restaurant!
As far as I know there have not been any reported cases in Tanzania (yet?). People ARE worried about a possible pandemic. The CEO of VSO sent out a mass email the other day warning people about this possible pandemic. And doctors in the hospital here in Lindi are talking about swine. We are scheduled to listen to a presentation on Swine Flu on Wednesday.

Other hogwash worth mentioning - a bunch of bombs went off in Dar Es Salaam last week, killing about sixty people (I believe that is the number quoted). I don't know how or why the bombs went off but it caused alot of panic among people living in Dar. As far as I know there are no bombs here in Lindi, or so I'm told!

On a very sad note, on Thursday evening, as I was about to go to sleep, I received very disturbing news. One of the VSO volunteers had been involved in a traffic accident and died while riding her bike in Tanzania's capital city of Dodoma. I was shocked and very saddened by the news. I had spent alot of time with this person as we studied Intermediate Kiswahili together last year in Morogoro! Apparently I was told that the tire of a taxi blew out causing one of the buses in the street to swerve and knock her off her bike! I don't have all of the details about this case and I'm told that VSO is still collecting information.

Switching gears, I met my first 'Androgen Insensitivity Syndrome' patient on Thursday. AIS is basically a rare condition affecting about 1/1200 women in which the uterus and cervix does not develop. These people are 'phenotypically' women but have 46 xy chromosomes (genotypically male). The diagnosis has to be confirmed by karyotyping but I'm fairly sure of the diagnosis based on her presentation. She came in complaining of primary amenorrhea (never having a period) at age 21. I had to ask one of the Tanzanian doctors to help me translate counseling this patient as it would be a very time consuming, delicate subject to discuss and necessitate answering many questions! We ended up referring the patient to Dar Es Salaam for karyotyping and genetic counseling. She may need orchiectomy if she is confirmed to have AIS.

Friday was a holiday here in Tanzania. I spent the morning doing a bit of reading on the beach. In the afternoon I went to the 'football' stadium to watch two of the local soccer teams play. It was a blow out, 3-0. The local team lost. There were a few visitors who received nasty looks when they cheared for goals by the visiting team. I captured most of the game on video.

That's all the news I have for you for now. Enjoy the weekend!

Case of the day

This morning I examined a post op patient who had a c/section 2 days ago. She had difficulty breathing, was febrile with a distended abdomen and rebound tenderness on exam. I scanned the patient and found that she didn't have any significant amount of fluid in the abdomen or pelvis so we treated her as severe peritonitis with broad spectrum antibiotics.

A moment later, I was called to do an emergent ultrasound on a patient admitted in the female medical ward. She was admitted with severe constipation, nausea and vomiting and she too had a distended abdomen with rebound tenderness. Her scan revealed a normal size uterus with what appeared to be a small intrauterine gestational sac without a fetal pole or yolk sac. There was a small adnexal mass and significant amount of free fluid in the cul de sac. I took her to the OR for laparotomy expecting to find a ruptured ectopic or ruptured hemorrhagic ovarian cyst. However, on opening we found diffuse, grossly dilated loops of small bowel with diffuse adhesions throughout the abdomen and pelvis - an acute small bowel obstruction. We ran the bowel and found a small area of ischemia however, no gross devitalized or necrotic tissue, so we performed extensive lysis of adhesions and closed. She'll get a nasogastric tube for at least 48 hours and conservative therapy post op.

The maternity ward was busy. I performed a cesarian section this morning on a patient with cephalopelvic dispraportion (CPD). It was her first pregnancy and she was lucky to have come to the hospital in time to be evaluated before potentially ending her pregnancy with a bad outcome!

More to come...

April Showers

We've had a few days of rain this month and just brief showers today. April is usually the last month of rains before the dry season from the beginning of May until around November.....

Practically this is not a good thing for me because I collect the rain water to use for bathing. Without rain I am buying water. Today I used up the last remaining drops of the water which I had collected from the rains. There was no more running water this morning so I went to my neighbor's house to buy about 20 liters of water (for almost $1).

At work its been busy as usual. There are always about 30-40 patients a day in the outpatient clinic. But towards the end of the week, the numbers usually decrease a bit. On Thursday I went on a "supervision of study", meaning that I travel to neighboring cities of Ndanda, Mtwara and Nyangao to visit the participating hospitals in this study. We are working on the "Misoprostol in Retained Placenta" Study. Patients with retained placentas are randomly given a placebo medication vs. misoprostol at the time of diagnosis of retained placenta. About once a month I travel to the three other participating hospitals along with one of the head Maternity nurses to follow up on the progress of the study. Its nice to get out of Lindi and to see the country and as well see people who I used to work with in Ndanda. But its a long day, we leave around 9 in the morning and get back by sunset.

My last day of work will be June 17th. I'm traveling up north to Arusha the following day and then going on a safari in Lake Manyara, Serengetti and Ngorongoro. June 23rd I'm flying back to the States. This means that I have only about 6 weeks left here in Tanzania! I'm sure the time is going to fly by. There are so many things I'm going to miss and a lot of things I'm looking forward to leaving behind here in Tanzania. I've started to compile this list and I'm going to publish in one of my upcoming blogs!

Duty Calls

Its been so busy at the hospital this week. Maybe because Tuesday was a national holiday and as well tomorrow and Monday are holidays. Everyone who is sick or just passing by the hospital is coming in for a health check up. It looked like hundreds of people had gathered around the reception area this morning to get a chart in order to see a doctor. About forty or fifty patients were seen in the ob/gyn room. Patients had everything from normal pregnancies to various gyn cancers.

I started the day with one elective cesarian section for a woman in her third pregnancy at term who has a "bad obstetric history". She delivered a healthy male who came out screaming.

After the elective c-section, I went to the OPD to see patients and then finished the day at ultrasound scanning patients. I saw a few interesting cases - one patient was a consult - she came with acute appendicitis and one woman I scanned had a bladder cancer.

I was home by about 5 and ate one of my favorite dishes - baked chicken with rice and vegetables.

The sun sets around 6:30 these days and if I'm lucky to have electricity at night I've been spending my evenings relaxing watching the second season of "Dexter" on DVD or doing some light reading.

I've notified the hospital here in Lindi that I'll be returning home to the States early. June 23rd is my expected date of departure from Tanzania. I'm planning to spend the weekend of the 19th up north around Arusha and Serengeti National Park.

For those who don't know already, I signed a contract for work when I was back home in the US last month. I'm going to work for Carlisle Regional Medical Center in Carlisle, Pennsylvania. July 13th is my start date! Very excited! Carlisle is about two hours from DC/NY and Baltimore in Central/Southern, PA close to Hershey and Harrisburg. See the website www.carlislermc.com

April Fools

Yesterday morning my 'program manager' in Dar Es Salaam called to tell me that the VSO office is conducting an Evacuation Test. If, for example, there was political unrest in the country and all volunteers were needed to evacuate, we would need you to follow the following instructions, he said. He told me that I must go to Mtwara right away. From there I would go straight to the airport, board a flight to Dar Es Salaam and get a connecting flight to the US. He asked me if I would be able to leave the hospital right away or if I would prefer he would call the Doctor in Charge of the hospital. I told him to call the Doctor in Charge. Two minutes later he called me and told me that a car would be available for me to leave the hospital. He told me that I should pay for the fuel to take me to Mtwara and then I would be reimbursed once I arrive in Dar. He said that the VSO office will be closed for four weeks during this evacuation, so I should plan to pack my bags to stay out of the country for the entire four weeks! I told him that I am really not ready to take a two hour drive to Mtwara, fly to Dar and then potentially fly back to the US, especially having just recently flown back here from the US. He told me I should go ahead and pack my bags and take the car to Mtwara. He said I should expect a call in two hours to get an update. I said to him, 'do you really want me to take a car to Mtwara even though this is a test?' and he said yes - I should go ahead and do it! I said 'But I don't have a ticket to fly to Dar!' He said yes, you do, an e-ticket has already been issued for you which you will receive at the airport. And once you get to Dar you will receive the e-ticket to return to the US'. He told me I would be flying Emirates and have a layover in Dubai. After more questions and more answers, he convinced me that I needed to get in the car and leave Lindi.

So I found the hospital driver, went to my house, packed a couple of suitcases and then began the drive to Mtwara. Two hours later my phone rings; my program manager tells me that I must return to Lindi right away; this was just a test. A test! What?? He said 'I thought I made myself clear on the phone', you were not supposed to leave Lindi!

I don't know if I was the victim of a bad April fools joke or if I just completey misunderstood my manager in Dar, but what a frustratingly painful thing that was to go through yesterday. I wasn't laughing when we had to stop the car and turn around an hour and a half away from Lindi!

Apparently the program manager's 'Evacuation Test' had the same effect on many of the other volunteers in the region who were also en route to Mtwara! There was an apologetic email sent out to all the volunteers who, like me, took the Evacuation Test seriously.

On a better note, today was a productive day. I had one operation scheduled this morning - an abdominal hysterectomy on a perimenopausal woman with a large fibroid uterus. The uterus was about three times the size of normal with large fibroids. The case went smoothly without any complications. I spent the afternoon in and out of the clinic as well as in ultrasound, scanning a few patients.

Happy April Fools Day!
More to come from the most gullible volunteer in Tanzania!

Bongo Flava

I arrived safely back to Tanzania 8 days ago. Nice couple of flights on KLM, with a short layover in Amsterdam. I landed in Dar Friday night and took a cab to my favorite hotel, the Econo Lodge. I spent the weekend relaxing and trying to adjust as quickly as possible to the time difference (8 hours ahead) here in Tanzania. The weather has been just as I had left, hot and humid, day and night!

I spent Saturday at the beach relaxing with another volunteer based in Dar Es Salaam.
There are plenty of "resort" style beaches in Dar and if you go to one of the more popular beaches on a nice weekend you'll find a ton of "wazungus" (White European descent) lying out or walking around. Almost gives you a feeling like you are not in Tanzania but at a resort in the Caribbean!

On Monday I stopped by the VSO office to meet with my program manager to discuss how the job in Lindi is going and to discuss other issues coming up in the next couple of months.

I flew down to Mtwara (the largest city in Southeast Tanzania close to Mozambique) on Wednesday and from there I took a dala dala (overcrowded public transportation minibus) to Lindi (about two hours north).

In Lindi I took a cab back to my house in the town of Mtanda. There I met Hadija, my housekeeper who I was happy to see and to hear that everything had been well at my house, i.e, no robberies or attempts at break-in.

I found the house just as I had left it - without water and with very sporadic bouts of electricity that seem to come and go at completely random times. My first night back in the house I had no electricity for most of the night. I spent the evening with my security guard sitting around in the dark talking by candlelight. I was lucky to have about 25 liters of water which had been collected from a recent downpour but that water was soon consumed and I'm now left with buckets of water used very sparingly!

I went back to work at the hospital on Thursday. I spend most of the morning doing "ward rounds", meaning I see all the Maternity patients (antepartum, post partum and laboring patients) and Gyn patients who are admitted in the ward. Fortunately there were no very sick patients in-house. We had a few patients with prolonged hospital stays due to post op wound infections. There was one patient admitted to the gyn ward with a large adnexal mass awaiting surgery and another patient in preterm labor at 32 weeks of gestation. In the afternoon I went to clinic and saw about a dozen patients. The most interesting case of the day was a relatively young woman who was diagnosed with cervical cancer. She went to Dar Es Salaam last year to receive radiation therapy. She came for a follow up and seems to be doing well with normal blood counts, however on exam she still has evidence of a large residual tumor mass on the cervix. I told her that she should go back to Dar Es Salaam to potentially receive more radiation therapy. There were two or three patients with infertility who came and got a work up. I scanned about a dozen patients in ultrasound and then went home for the day.

Hadija had prepared fish (red snapper) with vegetables and rice. It was plenty of food for me with leftovers remaining for the next day.

On Friday I had two operations scheduled - an elective repeat cesarian section and tubal ligation for a woman who is HIV+ with a history of one prior cesarian section and undesired fertility. She had an uncomplicated repeat cesarian section and delivered a vigorous baby boy.

The second case of the day was also HIV+. She was a young woman with a large ovarian mass. We found about a 10cm hemorrhagic ovarian cyst at laparotomy and performed oophorectomy. She was recovering well when I checked on her at the end of the day.

I saw a few more patients in clinic yesterday afternoon. More infertility patients arrived and a few patients came for regular antenatal care.

Last night I went to the Santorini bar, a nice local hangout on the beach to relax and get a drink. The laid-back social scene here is something that I will miss. There are no "wazungus" which I socialize with outside of the hospital, but there are plenty of friendly Tanzanians who like to relax at the bar and go dancing until early hours in the morning.

I'm heading to the market now to stock up on some fish and meat, fruits and vegetables and then do a little bit of work at home. Badaaye! (See you later!)

A Taste of India

Had dinner at Rasika (http://www.rasikarestaurant.com/) this evening. Excellent food! Their "flash fried" spinach appetizer was voted best appetizer in Washington DC! The cod, chicken and lamb were excellent. Service was good, but we waited an extra long time for the cod to come out.
I say "extra long time" with tongue in cheek because coming from Tanzania, one can expect to wait upwards to two hours for food to be served in a restaurant and then of course you can expect your food to be served cold. Many of the local Tanzanians will jokingly saying "TIT" meaning "This is Tanzania" when referencing the long wait for food at restaurants.

There's no "flash fried" spinach appetizers in Tanzania. Its even difficult to find a good chicken dish. There are a few good Indian restaurants in Dar Es Salaam, and the quality of food seems to be getting better, but the food in Tanzania doesn't compare to the food in the States, as you can imagine.

So, I'll be back in Tanzania in 3 days. Thursday evening I'm flying back. I've got a 10 hour flight to Amsterdam and then about 10 hours from Amsterdam to Dar Es Salaam. Once I'm in Dar, I have an option of taking the 10 hour bus ride from Dar Es Salaam to Lindi (2 hours of unpaved road) or taking a 2 hour flight. I think I'm going to opt for the 2 hour flight!

Besides adjusting to the 8 hour time difference, it will be interesting to see how quickly/how difficult it will be to communicate in Kiswahili again. When I left Tanzania last month I had been almost fluent in Kiswahili. Speaking and comprehending Kiswahili was easy. I was even thinking in Kiswahili! These days I find myself searching for words when I imagine speaking in Kiswahili again.

So, I only have two more dinners, and two more nights to spend with family and friends!!! I'm going to miss the food and the company of friends and family!! And of course the addicting evening TV series "The Apprentice - Celebrity Season". My question to you is, Why did Tom Green get "fired" last night?? He was a good manager, even though his team did loose to the girls by over $400.....

But getting back to Tanzania will be a nice feeling. I'll be happy to be back even if it is for a short period of time. I'm finding myself missing the hospital and being in the clinical setting. Despite the endless lines of patients, the never-ending ultrasound scans, the unpredictability of the electricity and the frustration with medical personnel, I am missing my work which I only remember with great satisfaction and personal fulfillment.

Cheers!

Red, White and Blue

It feels great to be back in the US!

I arrived in DC last week (last Friday), after two days of flights and a 10 hour bus ride. I was exhausted from the jet lag but once I landed and got in the car at Dulles I went straight to a restaurant in Georgetown and ordered a nice big juicy burger! Forget about the fat or calories, the burger is something that I have been craving for about the last 6 months! It was excellent too, nice and juicy! I don't want to complain about the food in Tanzania because I have an excellent housekeeper who is a great cook, but there is nothing better than indulging in a great beef burger!

After I digested my food, I settled in for the night as it was about 4 in the morning to me. Fortunately I think I adjusted to the time difference pretty quickly but I was battling a little bit of a cold the first few days back! The weather is so colddd! But it actually feels great compared to the swelting heat blaze of Tanzania! I know most people are probably hating me for writing about nice cold weather about now!

Well I want to fast forward a bit. Its been a week since I've been back in the States and I'm very happy to say that I feel like I've brought myself up to speed on all of the latest news with the global economic crisis. I've been glued to the tube watching CNN and MSNBC!

There were a couple of great panel discussions broadcast on CSPAN today, the first panel was a group of UPenn business/economic/finance professors discussing the state of the economy. And in the the last hour there was broadcast of the 'World Economic Forum' from Switzerland.....very interesting to hear some of these politicians and businessmen speak about these issues. From my perspective it is great to get caught up on all of the latest news but I would imagine for most Americans, reading the daily headlines of housing foreclosures and people loosing jobs must get depressing!

Anyway, that is about it. I'm thinking if possible I want to make a mini trip to NY in the next couple of weeks to visit friends. We will see.....

Happy Belated Valentines Day. There is no romance in the air for me this year, hopefully next year:)
Bye Bye

What are you, chicken?

Don't count your chickens before they hatch. Well I'm counting my chickens and as of today they are two! For about eleven dollars I bought two chickens in the market (live chickens, not the kind wrapped in saran wrap in the frozen section of the supermarket). The plan is to raise chicks for fresh eggs and after they "beef up" abit, I plan to enhance my diet with a variety of tasty white meats:) I took this picture because, for some reason I'm not ashamed or embarrased to prove to you that, I am now the (proud) owner of two chicks:)

As far as my dogs go, I'm sorry to say that my remaining dog, McCain passed away yesterday morning. She was so depressed, she wouldn't eat or drink. She died peacefully and for that reason I'm partly glad that she won't suffer from the loss of her brother and sister any longer.

At the hospital, work has been going well. Today I saw about twenty patients in the clinic, which has been about the average number of patients I see in clinic each day. In my down time I pass through the maternity ward or go to ultrasound to scan pregnant, and gyn patients.

There were a couple of interesting patients. One patient came to me telling me she had a 9 month pregnancy with symptoms consistent with an upper respiratory tract infection. She told me that she had been feeling fetal movement up until the last week. She showed me her antenatal clinic card which had documented her antenatal clinic appointments for the past few months. On exam she was obese and had a slightly distended abdomen, although I couldn't feel the fundus of the uterus. I scanned the patient and it looks like for the past nine months, her "pregnancy" was in fact an ovarian mass! The uterus was normal size and the cavity was empty. I informed the patient that unfortunately she won't be expecting to deliver a baby any time soon.

Yesterday I received a not-so pleasant surprise from Tanesco (Tanzania's Electrical Supply Company). One of the electricians came to my house and literally pulled the plug on my electricity. He told my housekeeper that he was cutting my electricity because I haven't paid any of my bills since I arrived in the house in September. (None of the bills had ever reached my house or the hospital btw). So today I went to Tanesco and received a bill for the months of October through December which totaled about twenty-six dollars. I also received my bill for the month of January which came to about one hundred dollars. I laughed when I saw the amount of the bill and argued with the manager, but he insisted that the amount is correct. To make a long story short, I now have electricity again and I am waiting to hear from the hospital as to whether or not they will reimburse me for the cost of electricity.

Tomorrow is an OP (operating day). It will be a light OR day as we are preparing to move into the newly constructed operating room. I have one case scheduled - a rescue cerclage for a woman with an "incompetant cervix". She has a pregnancy of twenty-two weeks with a cervix dilated 3 centimeters (and no preterm contractions).

Sorry for such a lengthy note today. I think I've cheered up a bit since the death of (all of) my dogs this week:( And in addition, I'd like to ask you the following question - What are you, Chicken? Bwak Bwak!:)

A Day of Mourning

I am feeling so depressed! I woke up this morning, started getting ready for work, and just as I was finishing my breakfast, my guard informed me that one of my dogs, Bush died! I went outside and there she was lying dead next to the dog house:( I was literally dumbfounded and shocked to see her lying dead.

Last night Bush and Obama had snuck out beneath my fence and wandered around. Obama came back very late last night around 10pm looking ill. Bush didn't return until sometime during the middle of the night and then was found dead this morning!

Meanwhile I went to work and tried to be productive while feeling depressed and wondering how my dog could have died! A little later in the morning I got a phone call from my housekeeper that another one of my dogs, Obama, was looking very sick. I went to the market to buy some dog medicine and when I got back home, I found Obama dead! He was lying next to the dog house, dead!

My last dog, McCain was the only one who didn't sneak out last night and she is healthy as far as I can tell.

It sounds "cheezy" to say, but I am really choked up and feeling very sad about losing two of my dogs (on the same day!). I was really attached to them after only four months! And what really kills me is seeing McCain run around the property looking for her brother and sister!! I am embarrased to say that I was almost in tears this afternoon....

Who knows what happened when Bush and Obama snuck out last night but something terrible must have happened. Both dogs were doing fine just a couple of days ago! I was thinking that possibly they may have acquired a terrible stomach virus after eating part of a dead animal last week, but there is something to be said about both dogs dying one after another after being outside my property last night.

The last dog that I had, Lucy, passed away a number of years ago and I forgot how painful it is to loose a dog...... its like loosing a family member! And to loose two dogs on the same day is painful!

Who knows what a dog's memory is like but I think McCain must know that her brother and sister are dead because she saw my security guard carrying Bush's body outside the property this morning and she walked with me while I carried Obama outside later in the morning. I just hope she doesn't have such a good long term memory!

I'm trying to keep my mind off of the tragedy today. But its hard! One of my drivers asked if I will get new dogs....the thought of getting new dogs hadn't even crossed my mind. Its too painful to get attached to these dogs and then loose them!

I'm sorry to leave this blog on such a sad note, I'll try to cheer up and post something on a more positive note next time :)

Hope

Inauguration day! What was it like in Lindi Tanzania?! Well fortunately CNN broadcasts live in southern Tanzania. Hours before the swearing in ceremony, I sat and watched, glued to the TV as I saw millions of Americans on the mall surrounding the capital. What a feeling of national pride, unity, great anticipation, and celebrations; I could only imagine all the emotion of a changing of power which were palpable in DC. What a great moment, but mixed emotions for me living in Tanzania, watching such a historical day for our country on another continent.

The moments building up to the swearing in ceremony were growing, more excitement, more emotion. Finally, just before 8pm, an announcement was made that the swearing in ceremony of VP Joseph Biden was to begin. There was a moment of silence and then..... darkness! The power cut out! Just as Joseph Biden was about to be sworn in.....absolutely nothing but darkness and silence. I lit a few candles and sat around and waited. And waited longer. Finally electricity returned just as broadcasters announced "And now the presidential party will leave the platform"....what a disapointment! The electrical company here, Tanesco, really dropped the ball. No one in Lindi could listen to President Obama's presidential speech! I'm so bummed.

Its great to watch the luncheon and listen to the commentary, to see all of Obama's staff and listen to his proposed agenda for the next few days and watch coverage of such a remarkable historical occasion. But I missed his inaugural speech! And apparently the Supreme Court Justice "screwed" up part of his inauguration speech. I'll just have to watch the speech on You Tube i guess......

I'm watching CNN now as the parade is about to begin down Pennsylvania Ave. I miss DC!

Only 3 weeks until I'm back in town. Definitely looking forward to returning home!

Trouble Makers

In the middle of my clinic this morning, two of the COTC students informed me that there is a "special case" in labor and delivery - a "cord prolapse".

I ran over to L&D to find a laboring patient with a cord prolapsed out of the introitus about 4-5 cm and a baby in footling breech presentation. I was surprised to find a fetal heart rate, although the baby was in acute distress with a prolonged bradycardia. I called for emergency cesarian section and the patient was rushed to the OR. In the OR I "splashed" the abdomen with an antispeptic solution and started my "crash" c-section. What we found when entering the uterus were two girls weighing 2.0kg and 2.45 kg both with apgars of 9/10 sitting in breech presentation.

I finished clinic around 3 this afternoon and then passed the ward to find the baby sisters and mother doing well.

Giza

Giza means darkness in Kiswahili. If you say giza, everyone generally understands that you mean that there is darkness because the sun has set or because there is no electricity and therefore no light! The latter has been the case here in Lindi the past couple of days! From morning until evening, we've had no electricity. When there's no electricity I still see alot of patients in clinic but the patient's can't get any labs drawn and can't get any imaging. If you saw the scene at the hospital today, you would have seen a ton of frustrated, tired patients waiting around for the electricity to return. Fortunately we don't loose electricity that often so on days when we do have electricity, I end up scanning a ton of patients in ultrasound.

This evening I got lucky, the power returned just before sunset. I wasn't so lucky last night. The power didn't return until around nine at night.

I took the picture above last night. I am a fan of candle light dinners; but not when I'm eating alone! Especially when I'm eating alone at home in the dark by the light of a couple of candles! Fortunately that doesn't happen too often, but when it does, its depressing!

Tomorrow is an operating day. There are a couple of laparotomies for adnexal masses and one excisional biopsy for a breast mass. I also promised the students at the COTC that I would teach tomorrow. I postponed my lecture today because there was no electricity. There is chalk and a chalkboard but I've been preferring to give power point lectures. And I can't use the projector when we don't have power.

I finally booked a flight back to the US. February 12th I'm flying KLM. Connecting through Amsterdam and then flying into Washington DC. I'll be in the States for 3 weeks! Definitely looking forward to the time home. I want to visit everyone! But its also easier if everyone comes to DC to visit! You are welcome to stay with my parents,:) sorry I don't have any permanent residence in the States these days to invite you to visit me.

Thirty-something

Watching paint dry. That's about as exciting as my birthday has been today. I'm exaggerating a bit, but nothing special has happened nor have I planned anything special for my B-day. I went into work as usual this morning. I did one cervical cerclage for a woman with an incompetant cervix this morning and then I went to the clinic. Clinic was very busy today, lot of overflow from the new year's holiday. I saw twenty-two patients by mid afternoon and then scanned about a dozen patients in ultrasound. Today was UTI (urinary tract infection) day in clinic because about seven or eight patients came with a urinary tract infection. There were also a few interesting cases. I saw one woman with a very large abdomino-pelvic mass which may be an ovarian malignancy. She will have an operation next week. I saw two patients with cancer - one with a bladder cancer and another with metastatic breast cancer. I expect both patients will be referred to Dar es Salaam for treatment.

I finished work around 5 and then went home. Hadija, my housekeeper, prepared an excellent meal - baked fish, rice and vegetables. It was the highlight of my day. I am planning to celebrate this weekend. On Friday I'm going to go the popular bar Santorini with a few colleagues to get a drink or two and then I expect to go dancing at Magereza's "Social Club" after. There is always "bongo flava" music playing until early hours of the morning.....

I'm planning my trip back to the States. Hopefully by early February. Hope my friends and family will have some free time in February. I want to visit everyone. We'll see how that goes!

Sorry I don't have any interesting pictures to post today. Despite the expression on my face I am happy its my Bday but not too thrilled I'm another year older!

Welcoming the New Year

Happy New Year! I spent New Year's on the beach at Santorini Bar with colleagues. We had a few drinks and then after midnight went next door to "Magereza's Social Club" to dance to some "bongo" flavor music.

The first of January is a National Holiday so I spent most of yesterday relaxing. I went into the hospital in the morning to check on a few patients.

Today was a busy day with two operations, one TAH for a woman with symptomatic fibroids followed by a vaginal hysterectomy, a/p colporrhaphy for a woman with pelvic organ prolapse. Both operations went well. There were a bunch of patients to scan at ultrasound and then I made a quick stop in the ward to check on patients.

My internet is finally back after about a week and a half of no internet because the land line was not functioning. But with luck, the one and only TTCL technician was able to fix the problem.

This weekend will be relaxing. I'm in the process of trying to plan my trip back to the States. Looks like I will be able to make it early February for three or four weeks. I hope my friends and family are going to be free next month....hint.

Happy New Year, I hope the new year is a happy and healthy one for everyone:)