I then met up with Ron Eggert (rheumatolgist from the States who does long term volunteer work at Selian) who drove me out to Selian hospital in time for rounds. Selian is what you think about when you think "third world hospital". Open air. Scarce resources. However, there is something strangely satisfying about holding up an x-ray to the Tanzanian sun to interpret it, rather than sitting in some dingy computer room like we do in the States.
A few cases that stuck out to me from my first day on the wards. A young male presented with clinical signs of heart failure. Extreme JVD, tree trunk legs, ascites, crackles, hypoxia. Apparently had been admitted several times before over the last year with the same symptoms. lasix and captopril were the treatments initiated. He was sating 70% and just looked miserable. My mind raced through the causes of nicm in a young male. All I could think was this guy needs an LVAD STAT (too much Cards II training)-- ahh but no such luck. Lasix, ACE and a bed are the treatments we can provide. I wanted to scoop him up and take him back to 4E at the U. For learning purposes, he had a fantastic gallop I'd never heard an S3S4 like that before.
Middle-aged patient presented with SOB. CXR showed complete white out of the left lung. Massive pleural effusion. Tapped the effusion- frankly bloody, no history of trauma. Took off 2L. Pt had been losing a lot of weight and felt weak over the preceding months. Differential for bloody pleural effusion? Cancer, trauma, parapneumonic effusion... maybe TB if it eroded a vessel. Can't really analyze pleural fluid easily (or cheaply), so can't really send for cytology. Pt can't afford a CT (which would have to be done in town at ALMC anyway). Tough situation. My palliative care self was happy he felt better after taking off 2L though. :-)
That was just day 1. So much HIV/AIDs. So much TB. Over the next few days I continued to work at Selian. The interns seem hungry for knowledge and appreciative of any expertise I can provide. I try to approach this humbly, as I am not there to take over or act like I have all the answers. I did ask if there are subjects they would like me to do some teaching on and they gave me a long list of subjects. basic stuff, like DKA, stroke management, cardiac physiology as it relates to heart failure.
I visited the plaster house. This is the organization that Ingred (Dr. Eggert's wife) works at. It is a compound of sorts where they bring children with various deformities (club feet, bowed legs, many different burn victims- lots of burn victims due to the open fit pits the Massai use to cook) that would otherwise be shunned by their communities. They pay for their surgery and then they stay at this house for the remainder of their recovery/rehab before they send the kids back to their villages. They do some schooling and feed them good food. It's quite remarkable. I met one little boy who had his entire face burned off when he fell into a fire pit that had a burning tire in it. He’s undergone at least 5 surgeries and has several more planned. He acts as an encouragement to the younger children and helps out a lot since he's been there a long time. I was quite impressed with the organization, although, for better or worse, it is highly dependent on western donors/volunteers. It costs about $1000 dollars to sponsor a child from start to finish (including surgical costs).
The weekend service was run by the interns (there are 2 right now), as the resident (or registrar) and Dr. Eggert weren't coming in. The interns asked if I wouldn't mind coming in, so I worked on Saturday too. I walked to work (about 1 hour each way) which was a beautiful walk through the countryside with Mt Meru in the background.
