Another week down. I'm just starting to settle into the routine of living here and I'm headed into my last week! I spent several days this week joining the hospice team. It was a very unique experience to say the least. I'm actually working on a short story about it. In short, I worked with a woman named Paulina. Some call her Saint Paulina and when you get to know her you see why. She's a strong woman, but has a gentle touch and soothing voice. She is greatly respected in the community and has invested her life's work in bringing hospice/palliative care to the rural Maasai communities. We did home visits one day this week. She wore bright pink dress flats... it had rained the night before... I was skeptical. Somehow she managed to expertly navigate the fields of bean, corn, and coffee to arrive back where we started with shoes relatively unscathed. I was now a believer. "Hospice care" is actually not hospice care, but more like home visits with a little palliative care mixed in. We saw a wide mix of patients, all meeting them in their little mud huts scattered throughout the country side. Some were near death, but most probably had years to live (which initially confused me because I thought we were doing Hospice visits). For instance, we met a young women who was a widow, as her husband died from AIDS. She was HIV positive. She had been faithful in taking her medications however and her CD4 count was in the 800's. She was otherwise doing quite well. Her neighbors helped her out some now but she had been a widow for over a year and had managed to maintain a fairly good life- she had a cow, and a goat, a few chickens who ran around my feet as we chatted. She had a small plot of land but it was enough to get by. Paulina said she was happy. I towered over her, hence the title of this update, and in fact, I tower over most of the people here. I figure I get as many stares because of my height as I do my skin color. I don't want to give away too much more about Paulina since I'm writing a story about her, but when it's done, I'll let you read it. :-). Needless to say it was a good experience. In some ways palliative care is more advanced here than any other medical field. Mark Jacobson believes it is the work he is most proud of accomplishing over the last 30 years: his help in building up the palliative care/hospice program in Arusha.
I saw interesting cases of tetanus and TB pericarditis. I diagnosed a lady with complete heart block using a little ekg reader attached to Ron Eggert's iphone. We are low on pacemakers though. I have continued to work on teaching the residents (registrars and interns) ultrasound skills. They seem pretty excited about it. I hope that energy will keep up after I leave. I think they are really starting to see the benefit of using it. I had them ultrasound me this week so they could see what normal looks like (at least I think I'm normal- I thought my aortic root looked a little big.. plus I'm kinda lanky and flexible so now I'm convinced I have Marfans. I have also discovered that my oxygen saturations are 91-94% at rest... I feel like that's a little low for a young healthy guy...am I becoming a little hypochondriac?). I think the patient's got a kick out of seeing me take off my white coat, take off my shirt and start having the African doctors examine my heart.
I did medicine clinic on Friday. I met this Maasai woman who had traveled 3 days to get to clinic... she got a PPI and seemed pretty happy about it. This interesting elderly Maasai gentleman also lumbered into our clinic- he was unusually overweight by Tanzanian (especially Maasai) standards so he seemed to be well off financially. He told me he had a breathing attack the previous day (he has a long history of asthma), so in order to cure it, he went out into his fields and performed a Maasai ritual that involved him killing a few cows. It didn't work. I asked how many cows he has: hundreds. "Whew" I thought, I was worried he slaughtered his only two cows to cure his asthma and that would have been a poor trade off. He said he had 5 wives and 30 children. I told him 1 was enough for me and he laughed. I asked if he could remember all his kids’ names. He didn't answer right away on this one... then he said, yes, but it would take him a while. Then he let out a deep belly laugh with a gaping smile that revealed only about 2-3 teeth left. He got some steroids and albuterol and was on his way. I think we would be friends if I were staying longer.
I went on Safari this weekend to Ngorongoro crater and Tarangari national park, it was quite fantastic and an enjoyable experience getting out of town for a few days. Chris (the surgery resident) arrived Wednesday night so he joined me on Safari. I told him I wanted to see a black mamba, but the best we could do was find a small dead one on the side of the road. We did also see a pride of lions munching happily on a water buffalo- that was pretty neat.
That's all for now. I hope things are going well in the good ol' U.S.of A.
Sincerely,
the Jolly White Giant.
