DR JANE’S DIALOGUE
Monday was our first real day. I left the innumerable volunteers and paid local staff to go out in the ambulance (two trips) to Kongo village to deworm the kids and check out the sick kids. We have 2 young 3rd year out Victorian docs, Caz and Kat, Billie also 3rd year out, our coordinator, and with us last year and an emergency dept experienced GP from Launceston. We have hired Dr Andrew from last year and Dr Ally from the government hospital, also Dominic a very experienced local nurse, with Diana and 2 other Launceston emergency nurses , a paramedic, a dental prosthesis cum bookkeeper, Dan the nurse who is busy pouring concrete for the newly dug septic tank at the volunteer house site, along with Ross Penny’s husband who drives the ambulance and keeps us all in good cheer, and of course David, who hasn’t got near his bees yet but is weighing and measuring kids instead, they are a huge crew.
My role is to work at Dr Winani’s hospital His wife Miriam controls all the finances etc, but now I am on my second trip, I can sweet talk her into letting me (and the antinatal clinic) have a blood pressure cuff ( that works) from her stash in the pharmacy, also a thermometer. I had lots of fun with the pulse oximeter this morning, all the staff wanted to be measured. Wish I’d brought my Peak flow meter, for the asthmatics. They get treated with IV aminophylline and oral salbutamol and prednisone.
Monday , I arrived at the hospital about 8.30, and followed a trail of blood drops to Dr Flavian’s room, where a man sat with cloth wrapped around his wrist , making a big puddle on the floor. I found a bucket to catch it, and Jill our paramedic handled him expertly. We got him down to the minor theatre (kerosene stove sterilised instruments) and I managed to prize a bandage and a gauze pad, out of the of the pharmacy, Young Fred, 2 year trained and not yet very experienced, was trying to suture with an enormous needle and full thickness catgut, very slowly. I managed to whip in a few stitches and staunch the flow, even someone found some local and popped it in, lucky man!!! Gill felt very needed and useful. We (Gill and I ) had gloves so I didn’t have to raid the locked Pharmacy again!!
Yesterday on the ward round we found the old lady whom Dr Winani had operated on 4 days prior for fibroids, found extensive Carcinoma of the uterus attached to bowel, which perforated, so he had to do a bowel resection, and was recovering well, nasogastric tube out, bowels working etc; excuse the long sentence!! She was completely out to it. They had given her 10mg of Valium and also the day before. BSL was normal, apparently she’d had some kind of fit. Well we didn’t do electrolytes, CT brain, etc ( 450miles too far away!) But the teary and loudly distressed relatives came and saw her, hired a taxi, crammed her in the back and took her home.
This morning I saw a staff members child, unwell, fever, headache, malaise “general body weakness”, a plump 12 year old girl. You don’t bother much with diagnosis until the lab results come back- 1-2 hours, She had Malaria 2 parasited per 200 WBc- ie a reasonable dose, typhoid (do you remember the Widal test- agglutination method,) strongly positive, amoebiasis and Schistosoma mansoni in the stool! So she gets 3 Quinine injections 8 hourly, IV in 500ml Dextrose (as they can get hypoglycaemic), ciprofloxacin 500mg bd 10/7 for the Typhoid ( with B complex vits also during treatment) prasiquantel for the schistosomiasis ( will have to be sourced from a town pharmacy as we don’t have any) and metronidazole for the Amoebiasis, so I expect she will soon get better. They also get Crystaline Pen 3 megaunits IM 8hourly x3, and Diclofenac 50mg IMx3 an expensive and remunerative treatment for the hospital??
I am much more comfortable with the drugs and diseases this year, and the Kiswahili is coming back quickly!
Our first day there was a woman on a syntocinon drip, G7 P4 2 neonatal deaths, at term with no foetal movement. She was eventually referred to the district hospital where she had a Caesar. Dr Winani, at 75 is over complex Caesar’s in the middle of the night. He really has amazing stamina.
PS I forgot to tell you, Diana Butler, the wonderful nurse who inspires us all (and who got me here in the first place) won her section of the Tasmanian businessperson of the year award. All very exciting, she had to do her acceptance speech through a friend as we were already here in Tanzania. David organised a great surprise celebration dinner at the local upmarket hotel The Goldilands and even sourced South African Champagne for the toast!! Care for Africa wouldn’t be without her care, effort, ability to love and relate to everyone, Tasmanian and Tanzanian alike. She is a charismatic ball of energy!! DR JANE JAMES