Marking their territory

Don't let their innocent faces fool you. These dogs have their own agenda and are becoming attention seeking, hyperactive, and severely dependant.
The other day I made the mistake of inviting the three of them inside my house. They were hesitant at first but after a few small fish treats, they made themselves at home. This evening, the three dogs snuck in through my front door. Bush starting gnawing away at my table, McCain was sniffing around under the sofas and Obama was busy urinating in front of the bookshelf! I sent them outside and locked the door to punish them for their unacceptable behavior!

On a separate note, work's going well. Its been busy with many patients! This afternoon we had an emergency c-section due to acute heavy bleeding in a 7 mo pregnancy due to placenta previa. Fortunately the baby did well. We took another patient to the OR this afternoon for currettage due to retained products and suspected placenta accreta after a normal delivery.

Tomorrow's a ward round day and Friday is supposed to be another OR day but there is a visiting surgeon in town from Dar Es Salaam who is operating for 3 days.

Unsettling week a bit because I lost my cell phone. I'm pretty sure I left it on the table in the guest house in Ndanda last weekend. I realized my phone was lost when I woke up from a nap on the dala dala (small bus) back to Lindi. At first I thought the guy sitting next to me stole it, but I checked his contact list and saw unknown list of people. So I figure that my phone must be in Ndanda. And there's no answer when I call so its looking like I'll have to buy a new phone :(

Jioni njema na kwa heri kwa sasa (Good evening and good bye for now!)

Sikukuu

Today is a sikukuu (holiday) here in Lindi. I'm not sure if its a national holiday or just a regional one, and I'm not sure what the holiday is celebrating. In any event I went into work today to check on the patients.

This morning my hospital driver didn't show up (because the hospital car had a "flat tire") so I started walking to the hospital. Half way to the hospital I ran into the electrician who was on his way to my house to install wiring to fix the water pump.

I turned around and walked back to my house with the electrician and waited while he installed the wiring (surprisingly only took him about 15 minutes). When he finished, I called the hospital and requested that a car come pick me up. By about 9:30 a driver came and took me to the hospital.

Arrived in maternity department and was surprised to see one of the assistant medical officers in the middle of examining a patient. I figured on a sikukuu he would be at home "resting" but I was pleasantly surprised. He is very committed and motivated to give good patient care....

The patient he was examining had a full term pregnancy with the fetus in footling breech presentation (in other words, the baby was sitting upright in the uterus with one of the legs extended and foot protruding through the cervix). Luckily there was no cord prolapse and the fetal heart tones were normal so we took the patient for a cesarian section.

Usually the anesthestists and nurses are really good about being efficient in transporting the patients from maternity to the OR and they were good again today; however, being a sikukuu today we had to call the anesthetist in from home.

Long story short, we waited about an hour for the anesthetist to arrive. Luckily the baby did fine with good apgars....

After the c-section, we had one post partum tubal ligation to do. The assistant medical officer told me he does this procedure under local anesthesia. I was surprised to hear he does this procedure under local, as I have always done this under spinal. I watched to see how much pain the patient would have and like I had expected, the patient had more pain once the AMO entered the peritoneal cavity; however, she didn't seem to be in a whole lot of pain.... After the tubal ligation, the patient walked back to the ward by herself:)

I passed back to Maternity to check on everything, and things were quiet, so I went back to reception to wait for the driver to take me back home. The driver almost arrived when a nurse said that two patients needed ultrasounds.

The first patient was really sick! She delivered a nonviable baby at another hospital about three weeks ago. Now she came with fevers, nausea/vomiting, abdominal pain and a very distended abdomen! The ultrasound showed very dilated loops of bowel suggesting an ileus. We admitted the patient to receive antibiotics and to get a nasogastric tube.....

The next patient came with abdominal pain and a large pelvic mass per the chart - the ultrasound showed a intrauterine pregnancy of 22 weeks. The patient was admitted for a further workup......

I went back home and fed my dogs (Bush, Obama and McCain). Then called for transport to take me into the town to run a few errands.

This weekend I'm going to go to Ndanda for a regional meeting. Just found out there was change in venue. I'm looking forward to returning to Ndanda and seeing everyone (almost everyone) and my old house......

I'm heading to a restaurant down the street to eat nyama ya kukuu and chipsi (chicken and chips).....next time I'm putting up pictures of my new dog Bush (who btw has had a bloody nose for the past two days:() She still wags her tail everytime I see her - nice of her to pretend she is happy to see me.....

TGIF

Thank g-d its Friday! Its been a busy week, not only at work but at my new home.
At home, I like to think I was pretty productive. I managed to get internet access, a plumber and new furnishings to make the place more homely. I still don't have running water, but the plumber promises by next week, the pump and water will be functioning. I like his optimism but I won't be holding my breath; I take what most people say around here with a grain of salt.

At work its been really busy. Which is good. I've been enjoying the work! I feel lucky to be working at a hospital which had two European gynecologists working in it for the past 4 years. There is a real Ob/Gyn Department. Now we are three, but the nurses are well trained as are the Assistant medical officers. There is equipment which is functional and staff who are capable of using the equipment. Unlike the previous hospital I was working at, there is a cervical cancer screening room as well as a radiology department which hopes to begin mammography soon.

The Assistant medical officers have been trained to do gynecologic surgeries and I think they are have more surgical skill than alot of graduating residents in US. That is not to say as a generalization that US trained gynecologists are undertrained by any means.

This week I spent the majority of the time in the clinic (outpatient department). Typically seeing about fifteen to twenty patients a day. The patients are a mix between obstetric and gyne patients, with all of the same complaints I'd seen during training - infertility, gynecologic malignancy, general gynecologic diseases, STD's, pregnancy related complications, etc.

When I'm not in the clinic I'm in the ward or operating room. This week I had two hysterectomies for symptomatic fibroids. The first was a very difficult case! The woman had a large fixed mass the size of a twenty week pregnancy. Probably complicated by pelvic inflammatory disease, the mass was fixed to the bladder and peritoneum with thick adhesions. She lost a lot of blood required two units of transfusion but had an unremarkable post-op course.
The second patient for hysterectomy also had symptomatic fibroids, but a smaller, much more mobile uterus, which was much easier to remove without any complications.

The language barrier is slowly breaking down, I mean its becoming much easier to communicate with patients in Kiswahili. Although much of what I say is the same to every patient, I think listening and communicating with people in Kiswahili makes it easier.

The doctor-in-charge of the hospital is the only functioning "radiologist" in the hospital, and he's been away at a meeting for the past few days so I've been doing a ton of ultrasound. I enjoy this because I never had a chance to perform much gyn ultrasound during residency, aside from first trimester family planning ultrasounds.

Oh, I almost forgot, I have another dog. Now that makes three. Her name is Bush. She is two months old and much bigger than my other two dogs - Obama and McCain (who are slowly getting bigger). Bush came to me about a week ago. She ran away by sneaking under the front gate the first day. She found her way back home about a few miles away. The owner brought her back a couple of days later. She snuck under another fence the next day and went back home. I was thinking of naming her Houdini for her disappearing acts but I like Bush better. She is very well received by Obama and McCain who are very happy to have a new friend.

Its going to be a relaxing weekend here in Lindi. Plan to go to the beach and swim tomorrow. Next weekend I'm going back to Mtwara for another going away party.
Hope everyone at home has a nice, relaxing, enjoyable and fun-filled weekend!:)

Obama and McCain in Lindi, 3 weeks old

I got two dogs. Named Obama and McCain. Don't ask me how I came up with the names, I just thought it would be a good idea to name the dogs after presidential candidates! That is Obama on the left, lying down and McCain on the right sitting up. Obama and McCain are brother and sister, Obama is a boy and McCain a little girl. No pun intended! They are both 3 weeks old!

The puppies arrived two days ago from a friend at the hotel I had been staying at. When they arrived, they looked so weak and helpless they curled up next to eachother inside their dog house and just slept. They are so afraid of me!
They did get a good meal of Ugali and small fish yesterday (Ugali is a staple Tanzanian food that is sort of a stiff porridge). People here eat it every day together with beans or vegetables, or meat, however, I've had no desire to try it. However, Obama and McCain love ugali and fish. After they finished their meal yesterday, I let them out of the dog house and they started to explore the backyard a little bit.

McCain seems to have more of a "curious" personality. She is always searching around and looking at me wondering who the heck I am and what the heck she is doing in my backyard!
Obama seems to be more relaxed and confident. Again no pun intended! He is more playful and yesterday he was rolling around in the dirt, I was thinking of stopping him, afraid he would get so dirty and get flees, but I just let him be.

Both puppies slept most of the day today. It is a sikukuu (holiday) here in Lindi today. I didn't have my household helper Hadija today so I had to go to the hotel and request ugali for the dogs. I gave them their food but they didn't each much. After a couple of hours I decided to add the little fish that Hadija bought from the market and then the dogs gulped down their food. Seems like Obama and McCain are a bit finicky with their diet, hahaha:)

That's about it from here. Hopefully will put up more pictures of Obama and McCain next time!
Also I am hoping to get internet installed in my house this week so I'll be able to skype and have time to write more without paying the hefty internet cafe prices.
Hope everyone is well at home!

New house in Lindi

I like my new house. Its pretty spacious - 3 bedrooms, two baths, living room and kitchen. The water isn't working yet, but hopefully the plumber will come on Monday. The house is mostly furnished, there's sofas in the living room and bed and dresser in the bedroom, but i'm still waiting on a couple of pieces of furniture to come this week.

I love the backyard, its really a lot of space. There are two mango trees and two banana trees. In one of the pictures you can see the back of my house from the the backyard. In the front, there is a little cabana like house that is supposed to house the "askari" - guard, however, I haven't hired a guard, yet, I like to use this space for outdoor cooking or reading, etc.

There's a dog house! Sadly, though, they told me that my dog ran away! I was so sad to hear this bit of news. Though at least i won't have to worry about feeding a dog or listening to any barking noise at night. If I find anyone selling puppies, i might have to get one.


The pictures above = the little cabana like space in the front yard where an askari can work (= sleep). The other picture is the front of my house.

There is a large gate that surrounds the house and the white gate with black doors is the "front" of the gate.

Above = the dog house. The picture above the dog house is a view of the back of my house from the backyard. Its probably a hundred yards of space surrounded by a gate.

Mangos waiting to fall. There still not yet ripe, maybe by next month

banana trees

The bed in the "master bedroom" The two other bedrooms do not have furniture in them yet, hopefully this week.

Work, weather, life, and other frustrations

Work has been going well. But very busy. Worked in clinic last two days and felt like i saw about one hundred patients. Had one case in the OR - a salpingectomy for a ruptured ectopic pregnancy. Tomorrow we have four cases scheduled, two VVF repairs, one hysterectomy and one anterior colporraphy. Hopefully we will have electricity because the last time we tried operating, the electricity went out in the middle of the case.

It is so hot!! By 9am it feels like about 100 degrees. This morning the hospital driver forgot to pick me up at the hotel so I walked to the hospital. Only a 15 minute walk but it was uncomfortable to be in the sun for that long! I'm trying to remember to consciously drink extra water because its easy to quickly get so dehydrated here!

Finally saw my house! Its nice! 2 bedrooms, 2 bathrooms, kitchen, etc. The house is almost on the top of a very large hill/very small mountain. maybe 300 or 400 feet above sea level? Its about a 15 minute drive from the hospital, the first 10 minutes is a drive up a very steep hill.
House comes with a dog. Have yet to see the dog, but looking forward to meeting him/her!
Too early to tell if electricity will be a problem, but seems likely that it will be an issue.

People are very friendly here! But sometimes they stare at me like i'm a alien from another planet with 3 heads. Its not too bad in the hospital because people assume i'm a doctor, but in the city, there are very few wazungus, so if people see a white guy, they definitely give you an extra long look!

My diet hasn't been great. I've been eating two meals a day because its been so busy during lunch time, i skip lunch. I eat a hard boiled egg and bread with margarine for breakfast and dinner is local tanzanian food which can be very tasty but usually is fried and unhealthy. There is one new very nice hotel which seems to have a nice restaurant but I haven't tried the food yet.
Solution seems simple. I have a "household helper" who is waiting to come and help take care of the house and who also is capable of cooking! And the market in town has some good looking vegetables. The fish is very fresh and there are plenty of butchery's scattered about.

That's it from here! Hope everyone's well back home.

Hotel Chemi Kumi and Hospitali Sokoine

I've been staying at the Hotel Chemi Kumi for the past week.
The hotel is located right on the beach with a beautiful view looking out into the ocean. Often spend quite a lot of time, while away from work, sitting at the restaurant chilling out, relaxing with a drink. Its so hot during the day that its nice to get a cool breeze from the ocean to cool you off.
There's a family who owns the hotel and the children and their friends manage everything and do a very good job. The kids do everything - cook, clean, wash clothes, etc. The other day there was a party at the hotel and about a hundred people came for the party. Local tanzanian flavor music was playing all night.
The rooms are small but "cozy". There is usually no running water so I shower pouring water from a bucket over my head:) At least the water is hot:)

Electricity is an issue, in town and at the hotel it usually shuts on and off and the most unpredictable times.
Work has been going well. Spent the last couple of days working in the clinic. There are enough patients to keep me busy until mid afternoon. I usually finish work at 3pm if its a light day or by half past 6 on a busy day (last Thursday). Normally every Wednesday and Friday the Ob/gyn department has cases scheduled in the OR but didn't have any cases to do today. The main OR is under construction so we have been using a temporary OR near the eye clinic. The other day the electricity went out in the middle of a c-section. Luckily i had some light coming in from the window close by the OR table and we were closing the abdomen when lights went out, so it wasn't too difficult to finish the case:) but i'm not sure what happens when lights go out at night during a c-section. One of the nurses said that the anesthestist shines light from a cell phone onto the field to help the surgeon see. I'm not sure if she was joking or serious but wouldn't be surprised if she was serious. Fortunately there is a generator in the hospital so I think that the generator usually functions during the black-outs. There's also a lantern sitting in the changing room but i'm not sure if it works.
The hospital actually had 2 Gynecologist from Holland working up until last month. One of whom worked in the hospital for 4 years and made a very large contribution to the hospital - taught staff, brought in a ton of equipment, medications, and even started 3 research studies. Its definitely nice to have some foundation upon which to hopefully build upon. One of the Tanzanian medical officers was trained in some gyn procedures and now is capable of doing VVF repair and a few urogynecologic procedures in addition to routine general gynecologic cases.

The pictures are from Hoteli Chemi Kumi, and view of the ocean.