Today we started working at the Kaloleni “government hospital”, it’s really a multi-specialty primary-focused outpatient clinic, in Arusha, Tanzania.
We started our orientation in the Family Planning clinic. Here women learn about birth control and receive preventative gynecological counseling and services. The tables for this years’ services depict a predominant use of condoms and IUDs, then Depo-Provera & OCPs. All of these forms of birth control and counseling are provided for the patients free.
Next was the laboratory. Later today we saw a patient’s urine who was suffering from Schistosomiasis. I watched the Schistosome on the slide as it attempted to ‘hatch’ from the capsule, according to the technician the organism moves within the capsule as they attempt to hatch. I was very impressed as I’ve never seen a schistosome before and Brian tells me he’s only seen them on fecal smear slides. Later on Brian saw a Giemsa stained blood smear of a patient suffering from malaria with the smear ‘chock-full’ of parasites.
There was a small triage area, a minor theatre (minor procedural room) & clinics for: Diabetes & Hypertension, dermatology , eye, ante-natal, TB, HIV & a vaccine clinic. Anyone who can not be stabilized at the clinic in <24 hrs is transferred to either the district, regional or local private hospitals.
Patients over 60 & under 5 years of age receive all care, meds and vaccines free of charge as well as anyone’s treatment for pregnancy, Diabetes (oral Rx & DM1 insulin), Hypertension, HIV, TB & generally most chronic diseases, as well as the afore-mentioned family planning. All other treatment must be paid for at the governmental clinics but this covers most of the needs.
The major public health project of the hospital is “Know Your Status”. Funded through the US, this initiative aims to test everyone who recieves care at the hospital for HIV using a rapid reactivity screening test. Screening is free to all patients and done maximally once a year. Patients are allowed to refuse the test and continue to receive care however there seems to be many who are willing to be tested. This initiative started in August of 2011 and so far to date they have found 25 patients with HIV who were not previously diagnosed. After screening the patients are counseled about their status privately and anonymously with well trained nurses and an overseeing physician in small offices at the back of the compound. Overall this seems to be a very positive program. Those patients who have been found positive have had their CD4 count taken and are seen back 2 days after counseling to discuss treatment plans and results.
Unfortunately the places that we can really spend time at in the hospital are limited by language. Tanzanians speak Swahili almost exclusively with only some English speakers amongst them and at far more varied proficiency than in Kenya. (Kenya secondary schools, middle & high school, require English language & the medical school is in English with some Swahili.) So we’ll be working on our Swahili.
Today I had greetings drilled into me because EVERYONE is SO POLITE and nice. My usual Jambo is not cutting it here.
A: Karibu (Welcome)
M: Asante sana (Thankyou very much) – remember this from the Lion King, rafiki’s little song: “asanti sana, squash ban-ana, wee di wee di, wee di oh ana” – Shh don’t tell anyone but I have to think of that song every time I panic thinking “which one do I say back again?!” and now even when I’m not, lol.
A: Habari (Hello/How are you?)
M: Nzuri, Asante. (I’m Fine Thankyou.)
Today I spent my clinical time in the Eye Clinic. The Optometrists were very interesting to watch and speak with. We saw many patients with miopia, some with overlapping allergic conjunctivitis, cataracts & “lazy eye”. One of our patients was a ~17 year old African male, acutely post-blunt trauma to the eye resulting in prolapsed iris & both prolapse & subluxation of the lens (in otherwords the colored portion of his eye appeared to be bulging out of the white globe of the eye and the black center of the colored portion was misshapen and showing the lens to be displaced from it’s typical position). Don’t worry though – he was not in a lot of pain unless you uncovered the eye and shown light into the pupil, which causes it to constrict and … well HURT! He was immediately referred to a local eye hospital where an opthamologist could perform pretty urgent surgery to replace the lens and reduce the overall pressure within the eye.
Because my sneakers are still damp from pushing the van through the creek in Masai Mara the other day I wore my Vibram Five-Finger shoes to work today (I think it’s better than wearing flip flops which was the alternative). But what a stir I caused. EVERYONE was looking at my feet and commenting on my shoes (a similar stir was seen in Kenya but many more people seemed to notice here). Perhaps I should buy stock in Vibram or they should think about establishing stores in Africa as I’m sure they would be VERY popular very quickly, if only they weren’t so expensive. I wish I could get away with wearing them to the hospital or with my uniform in the US – I’d be so so comfy. 🙂
Kwa heri (Bye)
- Mchele/Mishel (uncooked rice – or the way that most people spell my name here, I guess I am just that white ;-D )