Thursday, February 3, 2011

This One's for Popsy

I got a special request through the grapevine for a blog posting so this one goes out to Popsy.

I have had quite the last few weeks. Starting 3 weeks ago I headed to the region in Tanzania called Mtwara to meet up with a Peace Corps volunteer working in a town called Ndanda. It was a LONG 13 hours on the bus with an interesting middle part, not yet paved and consequently plagued with some serious dust clouds... open windows means you end up eating quite a lot and get off the bus looking a bit like a scarecrow. Nonetheless made it to Ndanda where I got the amazing chance to talk to a doctor working in the hospital in the town (one of the best in the south)and sort of shadow this PCV for one of the days as he taught in the local upper school. Some very interesting and shocking stories about the state of hospitals and schools in TZ.

One that has kind of hung with me came from the doctor. She first told us that pain medications like morphine are illegal in Tanzania. To give us an example of what exactly that means, she told us about a man who came into the hospital with a perforated bowel (OUCH!) and managed to live through it all (the perforated bowel, the surgery and recovery)all without any pain meds! Another story was of a man who broke his hip and 6 months later wandered in to the hospital saying his leg was getting shorter... the bone was working its way up past his pelvis through the muscle and skin, they gave him crutches and sent him on his way. Makes me think the people living out in rural Tanzania are really made of different stuff, what an incredible capacity to live with discomfort and pain.

A even scarier/more shocking story came out after I asked about cancer treatments... turns out there is one cancer hospital in all of Tanzania and the hospital does not even have Chemotherapy drugs as their supplier has not been allowed/able to send in the meds (the cause seemed to be a really messed up hospital bureaucracy). This means that patients have to go to the wooden shack dukas (pharmacy like stores) to buy their chemo meds. To give you an idea of what exactly that means, from what I understand this is a drug (liquid poison) that needs to be kept at regulated temperatures and handled very carefully. In Tanzania the only place these necessary and potentially life saving medications can be bought is from places where there are definitely no refrigerators and probably have primarily expired meds. Was pretty shocking to say the least.

After spending some time in Ndanda I continued on to Mtwara town to meet up with another friend and was invited to her co-worker's house where I watched as he cooked our dinner on a open charcoal stove on the ground...he squatted hunched over cutting, boiling, and sauteing and making a final dish of chicken (killed earlier that day), veggies and ugali. No cutting board no table and only one burner! If I had to cook like that I think I would probably end up starving... my heart goes out to those women who work endlessly over such stoves so they can feed their often enormous family's. While I really came face to face with the difficulties of TZ style cooking it was a great time and fun way to end my week down south.

After returning home to some interesting drama with my landlady in Dar and a fun weekend with some friends I hopped another bus (30 HOURS!!!) to Kampala, Uganda to meet up with a previous Watson fellow implementing a project for the WHO in a local hospital. She is working on a data collection project designed to follow women through their pregnancies, tracking illness and medications taken over the course of pregnancy in hopes of finding some cause for elevated levels of physical disabilities among children.

I have spent the last few days with her getting some great insight into how essential proper training is. I have observed several training sessions designed to teach the nurses at the local hospitals how to correctly administer the surveys and collect the needed data. Even with all of the hours of training there are never any guarantees and of course endless, often unforeseeable complications with doing this type of long term tracking of patients. It has been really awesome to get the chance to ask this previous fellow questions about her work and experience, she has been so open with me and so willing to share; what a fantastic chance to learn from anothers experience.

It has also been incredible to kind of wander through the public hospital here. I can't believe how many people are in the huge industrial looking building and how dependent patients are on their families to care for them. Families are responsible for bringing everything right down to bed sheets. That means if you have no family you have no food, no clean clothes, and no meds; there are just too many people and too few resources for nurses to take on the types of responsibilities they assume in US hospitals. It is almost impossible to compare what I know as the hospital system at home to the one I see here.

On Tuesday we head out to a rural hospital site for more training sessions and then Wednesday I get on another 30 hour bus back to Dar. Passing through Nairobi and then continuing south... I think the Dar-Kampala bus ride wins the prize for longest bus journey yet.