The Trip and Week One of the Caravan

We’ve been here almost a week and this is the first opportunity that I have had to write.
Things have been busy and we’ve been working hard and making a difference, I think.

Leaving Canada was quite chaotic!!
Karen and I spent some time packing the supplies for the caravan and for the Tanzanians on Saturday but then the real craziness was on Sunday when we tried to create 30 (two per person leaving ) equal-weighted bags. It was a zoo!! And it is the reason that I have not quite figured out everything that I am missing that was in the bag that is still missing. The things I have figured out so far are: my T-shirts, my sleeping bag, my make-up, some of my toiletries, and possibly (oh horror) some of my Thesis information (I pray that I actually just left that booklet at home). We are having an extremely hard time tracking that bag because we do not know who checked it once we got to Montreal. One week later…still no bag! I hope your sleeping bag is warm, Roman, because that’s the one I’m using for the Climb!!
The chaos continued at the Montreal airport because 2/3 of our bags were in the second van that left one hour after us. I’ve NEVER seen the Montreal airport as busy as it was (we actually commented in the van abut how happy we were that we were leaving from Mtl not TO), so as most people waited in the long line to check in, Gary and I went to the doors to identify the other McCoy van and get the bags. We could have been a comedy show…taking two FULL trolleys each, butting in line to join the group, and then emptying bags and refilling bags at the weigh-in counter to further even them out when we were over-weight. It was hilarious!

Security also took a long time (again…I thought I was at Pierson). Note to self: do NOT pick the line with the family and little baby in the stroller!! They had to check everything!! We then had to RUN to get to the furthest possible gate as they were calling last call for the flight. We made it on in the knick of time.

It was a full flight and about half an hour into it, we began to realize that the fact that the only empty seat on the flight was smack-dab in the middle of our group, might indicate a problem. We spent the rest of the flight to Amsterdam looking for Val who had joined us in Montreal from Ottawa…she was nowhere to be found. We finally, with the help of the flight attendants, postulated that she waited at the wrong “Amsterdam” gate for the flight that was leaving 20 minutes after ours and that she must be on that one. The funniest part is that when we got up to disembark in Amsterdam, her head popped up from a window seat 2 row in front of our group!!! I have NO idea how we missed her for the whole flight!

The Toronto group met up with us on the flight from Amsterdam and the rest of the trip was uneventful.

It was a true homecoming for me. After making sure that everyone made it through with bags (and counting the bags to see how many were missing), Karen and I got to the other side of the gates. Seeing Agnes, Cherise, Abbas and Penninah was like seeing family. Driving to Moshi was like coming home. I really wished that the kids and Chris could be with me. We had diner at the Leopard and then were dropped off at our respective homes to sleep.

Sleep was short!! We went to the center to count pills, get oriented, and set up for the next day.

It was super to meet the 6 ladies who are cooking for us. They are all part of our program and have had micro-loans from us. Some sell veggies in Dar, some make adorable winter hats (I’ve already bought them for Sid and Adam), one makes beaded bracelets with Pamoja Tuneweza (the name of our center) on them…Frieda was there as well as a couple others that were residents at the Center in April. The biggest (pleasant) surprise, was that Gloria’s Mother is part of the team. Gloria was the 9 year-old girl that I met in Himo in April that had gone through puberty at age 4-5 and had been raped at age 8. We tested her in Himo and found her to be positive. Her 22-year-old sister was very unclear as to whether the family would support her getting medical care or whether she would be kept in Himo, or worse yet, ostrazed completely. In the past 6 months, through the hard work of Agnes and Peninah, Gloria is getting medical care, her mother has become supportive and been diagnosed and treated, herself, with HIV, and has started a business with Agnes where they pick veggies and rent trucks to take them and sell them in Dar. Agnes described the way they dress when they go… “like for the chambas (fields)”, in kangas so that they look poor and get more for their goods!

We went to Indo-Italiano for dinner and had a nice time, albeit very SLOW service. Pole, Pole.



Karen and I were surprised by how few people were waiting for us on Day 1. Although it was expected that things would be slow because, as Agnes said last caravan, “women will send their brave friends the first day to see what it is about” we thought that that phenomenon would be less obvious the second time around. It was a great day and people really had a chance to get oriented. Many of the caravaners are here for the first time, so a slow first day was just what we needed. We even had time for debriefing!!

The second day was also somewhat slow and so Karen and I started looking for reasons. The most likely is that timing was difficult…most of the announcements were made at churches and mosques and, as Agnes explained, attendance is often low at Christmas time. This was surprising to me until she explained that people are either travelling at Christmas, or they are working extra hard to make money from the travelers (often foreigners). Also, we did not advertise on the radio this year…lesson learned.

Anyway, things picked up the next day after we got some radio advertisements going!! In addition, we started our outreach project early by sending half the group to Chimbwe on Friday. We had already planned on going there the following Monday, but with the help of Irit, the wonderful wife of Elisha, one of my students, the town got mobilized on a few hours notice!! She had Bernardi, one of the elders, take flyers and go door-to-door. When we arrived on Friday, there were only about 40 people waiting, but they came out of the woodwork after that and we actually had to turn people away!!
Chimbwe is a village in the hills about a 45 minute drive from Moshi. They have very little access to medical care. A fantastic volunteer named Evelyn, lives there and helps to coordinate what care they get, through a program called Migeni. So we were able to identify any patient that required follow-up or tests to her. They have a system whereby they check on people at home within a certain amount of time to see if they have sought the care they needed. If they have not, and if it is because of money issues, Mageni takes over.
It was an interesting day and we pulled through despite a few glitches that were directly related to having planned the trip at a moment’s notice. We were missing a few types of medications, we did not have the legal consultant with us and we could not test people for HIV because our HIV counselor was in Moshi at the center. But despite those small downfalls, it was a huge success and the people who required those services were directed to return on Monday. It was also really nice to have that follow-up for people that we started on diabetic or hypertension meds as they were able to come for re-checks.

I think that the patient that affected me the most that day was an 18-year-old boy (who looked 14), who came to talk to Abbass and I. He started by giving non-specific symptoms, but we quickly realized that he really was coming to try to get help. Abbass asked him about his life and he told us that both of his parents were dead and that he lives with his uncle who makes him work all the time. He had been accepted to Form 1 (high school) but there was no money to pay for it. I was a little worried that he was HIV positive (due to his size and the fact that both parents are dead) and we had his come back on Monday for testing and to see legal. I had a really good feeling about him, as did Abbass and I was thrilled to see him back (first in line) on Monday. His test was negative and we had a conference with Evelyn and Bernardi to assess whether my gut feeling had been right about this kid. As it turns out, after talking to him, they found out that he desperately wants to go to school to become a teacher. They also got a positive vibe from him and he promised me to work hard in school and I agreed that PTE would cover the costs of tuition…200 dollars this year and 60 dollars a year thereafter.

Back to Friday…
The other half the group (the ones going on safari) stayed in Moshi and had a good turn out!!! They had to close the doors at 12 as a way to ensure being done by 3. This did not happen!! And when we arrived back around 2:30, there was still a lot to be done. It all worked out, though and Karen and I got new jobs as pharmacists since both pharmacists and the “pharmacy assistant…Tanya!!) had to leave!

We finished up and counted a few more pills and then called it a day!!

some photos

Getting ready for my next trip: notes sent to family and friends

Hello All.

Please see the attached word document.

If you are receiving this you are in at least one of the following categories:

Someone who I thought might be interested in a short account of what has been going on with the Tanzanian projects
An old friend with whom I have had little-to-no contact over along period and who’s email address popped up at me while going through my address book (there are a few of you!)
A colleague who might be wondering what the heck I am doing when I keep leaving for Tanzania
A medical person that might like to take part in a caravan at some point (actually…we need non-medical people, as well on all the caravans)
A family member
Someone from the hockey team who keeps hearing me talk about Tanzania!
Someone who donated to my last trip
Someone who might like to donate to the Women’s Center this year

Even though I finish the note with how to donate, I only put that there for those who are looking for a good cause to donate to. I realise that this year is very stressful for everyone and I don’t expect anyone to feel the need to help the Center at this time, when there is so much attention needed at home. That info is just there FYI.


Jenn

Hello to All of you.

I am writing to tell you about my next trip to Tanzania and to update you on my time there with the kids last spring and on the news about the Women’s Center.

We had an absolutely wonderful time. Many of you visited our blog, which ended about half way through the trip because we were in Kilema and the internet access was sketchy at best. If you want to visit the blog it is: http://carpenter-chardsintanzania.blogspot.com/

The highlights of the trip were:
The Women’s Center taking off:
The Women’s center, called Pamoja Tuneweza (“together we can”) is an absolute marvel, if I do say so myself! My dear friend Karen has spearheaded the whole thing but I have been involved in its development from the start. For a year and a half, the Center has been offering shelter, free legal aid, social counselling as well as micro loans and education in economics/running small businesses to women in need. At the start of my trip in April, we opened the medical part of it with our first “caravan” there. For those of you who don’t know, “caravan” is the term we use for a bunch of Canadians going over for two weeks and providing intensive medical care and free medications for hundreds of patients a day. Prior to our arrival, Agnes and Vicki, who run the place, advertised all over Moshi that we were coming and were going to offer free medical care. The ads worked…we saw hundreds of women and children (and some men) per day. We offered free HIV testing (with pre-and post counselling), general medical care (with free meds), toothbrushes that Sid and Adam had collected prior to departure (1000 of them!), mosquito nets, free legal aid and more. It was a HUGE success and left the center as a force to be reckoned with in Moshi. The wonderful Peninah, our clinical officer from Kenya, did the caravan with us and is now running the medical aspect of the center when we are not there.

Working in Kilema:
After Moshi, the kids, Jess (my friend, public health student (and our nanny!) and I went to Kilema which is a rural hospital. We lived on the grounds of the hospital and I did some teaching and some learning in the hospital as well as at the HIV clinic that has been funded by CACHA (the Ottawa group with which we are affiliated). It is the place that Chris and I went to in 2007 and I really enjoyed working there again. However, I must say that the MOST fulfilling part of being in Kilema was watching the kids grow into socially-aware, carefree and independent individuals before my eyes. There were two other Canadian families with kids the same age that had been there for the better part of a year. The kids all got along wonderfully. In the mornings, they would do “home-school” with no adult supervision (the parents were working). Then they would all go to lunch together and then play soccer and explore the area with the local kids. I could not believe how quickly I became comfortable with having them “run wild” with no supervision. They were so responsible and gained my trust in the regard within days (at ages 6 and 9!!)



Seeing the Queen’s Global Health Program working:
Karen and I are Co-Directors of the burgeoning Queen’s Undergraduate Medicine Global Health Initiative. With the help of some VERY keen medical students, we have started an optional curriculum here in Kingston and we facilitated 10 students travelling to Moshi and Kilema to work and gain experience. It was a huge success and by the sounds of it, we will actually have to have a selection process this year because there are dozens of students who want to go this spring/summer. At the Center, the students were able to help and learn from Peninah, they take part in the workings of the center and interact with the residents of the shelter. They also went on home visits in villages with Agnes and developed contacts with other organisations in Moshi such as the rape crisis team. In Kilema, they gained experience by working with the physicians and surgeons, performing deliveries and taking part in surgeries and reading X-rays. They also got to spend time at the HIV clinic and do home visits with our HIV orphan program. All in all, I could not imagine a better experience for them.


In January, I am going back to do another caravan with about 25 Canadians (and a couple Americans). This caravan is a little different as we are doing a Kilimanjaro climb fundraiser at the end. It is called “The Women and the Mountain” and we are taking 5 Tanzanian women (4 of who are HIV positive) up the mountain with us. This is a HUGE deal as Tanzanians do not get to climb the mountain (the costs are prohibitive) unless they are the porters (none of whom are women). It is also a huge deal because it will do so much to raise awareness that you CAN be healthy even if you are HIV positive. We have a filmmaker coming to make a documentary. Each of the North Americans is expected to raise at least 6000 dollars (more would be even better). This will cover the costs of the caravan, medications and supplies, the African participants’ climb, and will leave about 2000 dollars per participant that will go directly to the operation of the Center. I have already contributed half of it (the costs of my travel and climb) but in case there is anyone out there who has been “wondering what cause to give to this holiday season”, I thought I would give you the information so that you might consider the Pamoja Tuneweza Center. This would help me toward my goal of raising another 3000 dollars (or more!).

If you would like to donate to the cause, you can do so at http://www.cacha.ca/donate.php . Go to that page and click the “Donate Now” button. Please make sure that you write “in the name of Jenn Carpenter”. You will get a tax receipt for anything over 20 dollars. If you donate, please also email me to let me know. If you are not able to contribute right now, don’t worry…I’m going again in October so I will be asking again!

Thank you to those who donated last time. It means a lot and I really feel that we are making a HUGE difference.

Thank you all for reading this. It is truly my passion!!


Happy Holidays.

Jenn




PS Here is a link to a YouTube piece that one of the participants put together (somehow I did not make it into any of the pictures, proving that I really DO shy away from the camera!)


http://ca.youtube.com/watch?v=2iM7gKz4fCw

Giardia and Worms oh my!!

Wednesday May 7th

…Unfortunately, Adam WAS sick again. He slept well all night and awoke with vomiting, abdo cramps and diarrhea. I am not sure what is going on…maybe a parasite from the water in the river?
I will just keep him in bed today and see how things go.
Of course that means missing another day in the clinic, which is very disappointing…but it just means we will have to come back again soon!!!

2 pm Wednesday
Well, I now know the answer to my long-time question: “when I ask for stool samples in ER, how exactly do the patients get them?”…disgusting!! Dr Mlai and Dr Bando were both around a lot today to see how Adam was doing. Dr Mlai sent the girls with a stool container and then came to pick it up once Adam had produced…I saw little white worms in the stool and Dr Mlai saw giardia under the scope. I think we have a double whammy and he is now on treatment for both!!

Tuesday May 6th

We had a nice day. We went to rounds in the morning, Christa saw a couple of surgeries, I spent some time with Dennis (clinical officer) in outpatients, and some time in the CTC. Then we went for a walk to the top of the mountain and the kids played with a group of girls that were up there doing their evening chore of cutting grass for the cows/goats. The kids had a ball. Eva and Sid learned how to use the cutters ( and taught them to do cartwheels and handstands. At one point Rachel (the least timid of the girls) took Sid’s hat off and stroked her hair, then she braided it and then took Sid’s hand and marveled at it. It was a beautiful exchange.
Dharma spun the little boys around and around and we joked that this would make Adam sick again…

“Party, puke, shop, waterfalls, peanuts, puke”

I have not written in a few days (it is now Tuesday the 6th), and when I mentioned that to Jess last night, she said “that’s easy…just summarize it as “Party, puke, shop, waterfalls, peanuts, puke””. She’s kind of right, but I’ll flesh that out just a bit!!



Last day at the center

Karen was away most of the morning, but unlike the other days that she was gone, things were very smooth. We had planned to work till 1 pm and then pack things up, debrief and PARTY. The only glitch was that about 75 extra people found a way to sneak through the gates, so we saw more people than we had planned, but we were still done at 1:15.
The patients that stick in my head from that last day were:
1. A very small three year old came with her mother who said that she would not eat. She had been seen many times at the hospital for this but they could not find anything wrong. Mom said that the only way to get the child to eat was the hit her with a stick!!! I just did not know where to go with that one!!
2. A 36 year-old man who was there with his wife. Both were positive and he had a “stroke” 4 years ago which turned out to be a fungal infection in his brain which left him with right sided weakness, inability to speak and difficulty swallowing. He was clearly a highly intelligent man, apparently fluent in Italian as well as English and Swahili (until, of course, he lost the ability to speak) and the love and support between them will stick with me.
3. Most importantly, for me, the 9 year-old girl and her sister showed up and we were able to introduce them to Agnes and get a plan going with them for follow-up. They were still unclear as to how supportive the mother would be as she had apparently been quite abrupt on the phone. We will see…she was to return from Dar that night. We gave them money for the Dala dala to return the next day…unfortunately, we had all forgotten that it was a holiday when we told them to come that Thursday… so they need to come again Friday to register with the Malawi CTC (“treatment center/AKA HIV center). I know Agnes will take good care of them.

Once the patients were gone, we cleaned up, packed things into the medical room so that Penninah and Carole White could arrange them over the next week and then the party started. The Frasers, Jess and the kids arrived for the party and we all danced for hours to the tunes of Dialo’s band. It was a perfect evening except that Abass’ camera was stolen with all his pictures for the safari with the caravaners.
We went out to dinner with the Fraser’s (10 in a taxi n the way!!) and went back to the Leopard and Adam woke up in Jess’ bed screaming “I’m hungry” and then proceeded to vomit all over the bed. Needless to say, he was then MY bed partner, not Jess’!!

Future plans for the Center

As the caravan comes to a close, it I worth talking mentioning future plans that Karen and I have been talking about (most of which need funding so friends at home: WATCH OUT!!)
As I already mentioned, we have rented a house near the center that we are furnishing so that Peninah and med students can have a place to live. There is a woman who lives on the grounds and she will cook breakfast and dinner for whoever is there.
We would like to buy a building in downtown Moshi that can be opened as a B&B for female travelers. It would be run by the women that we are helping at the center as a way to make money to keep the center sustainable but also as a training ground for these women who often have left unsafe situations but who have no means to make money because of lack of training and opportunity. They will learn the hospitality trade and English so that they are ready to take on new challenges in the future.
We are of course, planning the next women’s caravan which will be next January before the Kili climb. We will need funds for the caravan as well as for the fundraising climb. As it turns out, the kids might be interested in coming too as the Fraser kids have climbed to the base hut twice with no problems…we’ll see.
Penina is going to work on getting the clinic up and running, a functional pharmacy and some outreach programs. Carol White is there with her for a few weeks which is invaluable to us. We are hoping that Peninah can make some connections with the Baylor Pediatric AIDS foundation at KCMC so that we have an IN to send the positive kids that we discover to them. Often by entering clinical trials, people get better (and free!) care.

I am really exited about having Peninah at the center. It will be a new experience for her. As I discussed with her, this will be the first time that she is her own boss…usually she is told what to do but she will have to take initiatives on her own now. I think there will definitely be a learning curve, but I think that with our support, she can do it.

Friday the 2nd.

We got up and the kids and I went to the center so that I could finish up some work on the health info sheets. The kids played outside and took pictures of a baby (this piece of info will come back next paragraph!). We then went back to the Leopard to meet the group to go shopping. We went to a craft market that I had not been to before and spent a lovely couple hours looking at art and bartering with the craftsmen. I bought two paintings directly form the artists, which is a rare occurrence here.
Abass had met up with us and we needed to talk safari, so he came back with us (after commandeering a BUS to take us back!!) and we had lunch. We planned our safari and then Otto came to take us to Kilema. As we drove out of town, I again lamented that I could not find my good camera and Sid perked up that it was at the women’s center sitting on a chair!!! Thank goodness that Agnes had found it, or it would have been two cameras gone missing at the center in 24 hours!!
We arrived in Kilema and had the great pleasure of moving in to Bistra and Ivan’s home…two weeks of living out of bags is quite difficult, so it was hugely liberating to unpack!! A big thanks to B&I for lending us their house while they are in Mozambique!

What about School?

Throughout the last couple weeks, the kids and I have discussed the idea of going to the local school for a couple hours a day. It had been our plan, and I certainly thought it was a good one, but prior to coming here, I had not thought about Corporal Punishment. The Fraser kids stopped going to school months ago and have been doing morning school at their house (correspondence with a program in BC) because they told their parents that they no longer wanted to go. I know that the teachers would not touch the Mazungus, but I was not sure whether I even wanted the kids to witness the violence. I decided to leave it up to them, and they decided to do morning sessions with the Frasers. For the most part it is going quite well. It is difficult for Adam, being six, to apply himself to his work (which the wonderful Madame Brigitte sent with him) when there is no adult there, but Sid is helping him. There is no way that it will all be done by the time we leave, but I think that the experiences here far over shadow any book learning that can be done in 5 weeks!!

Second Kilema weekend

We have been so lucky with the weather…we spent the weekend doing out doors activities and were not rained on once. Saturday, was Orphan day in the morning, a kids soccer game around noon and then we went back to the Mountain Resort for a swim and to watch a game. The girls had a magical time of swimming, playing cards and doing each other’s hair. Adam played photographer with his tortoise and watched the game. Sunday we went for a nice hike led by Rainer and his friend. We spent a few minutes at his friend’s house in a village and met his kids. Then we took a “short-cut” which definitely ended up being a long-cut to get to a spectacular waterfall. Unfortunately we were followed by another “guide” who was a bit creepy, but all in all it was a phenomenal walk. We even got to swim in the river and the kids thoroughly enjoyed it.
We had a great game of Settlers. Dharma and Christa had Raha (banana wine) and I said that I would wait 24 hours before trying it to see their reaction and after effects (ie do they go blind or get gastro from the water used in making it)…so far so good. I might try it next time!

Monday May 5th

Unfortunately, Adam woke up vomiting at 12:45. It was disgusting!! Even before bed, when he was feeling well, he had a funny smell about him. The vomit was even worse! It was basically the peanuts that he had eaten on the walk. There were some real features of anaphylaxis to his presentation which reminded me of Christa’s comments during the day that she had been told that her absolute aversion to peanuts was probably an allergy. Adam has always had such an aversion to peanut butter, and now he was complaining of shortness of breath, abdo pain and lightheadedness all the while coughing/vomiting up thick mucous! He did this every 30 to 45 minutes until 5 am…I did not sleep at all and 8 o’clock sure came soon!
Unfortunately, this was to be my first day on the wards and I chose not to go in the morning because of fatigue, but as I saw Adam run and play as if he had had 12 hours sleep, I felt compelled to see some patients. The afternoon held a soccer game with the “big kids” (ie adults)…Sid and Adam played too and it was quite a sight to watch!
The other trauma today was the realization that Sid has lost her journal. She has been so good about writing her memoires both for her own recollections and to show Madame Marie-Claude. It was the only homework that she was asked to do. The loss was quite a heartbreak!!

Himo Day from Hell

Himo is one rough town!! I've been to many villages and towns in this beautiful country and I must say if he knew is very different from the rest of them. Tanzanians in general are cheerful, respectful, helpful and kind. The people in Himo, whether by choice or circumstance do not have the luxury of behaving in this way. Karen was busy again today and so I was attempting to run the show. We decided that since there were only seven consultants including the dining room, that we would limit our numbers to 150, but somehow 200 charts were given out, but what we felt confident that we could see them. The surroundings are not ideal for seeing patients. We were in a bar in tight building that was extremely dark and dingy. This made it very difficult to see the many skin disorders that people have. We continuously needed to take people decide to get a real look at their rashes.

There were some really sick people today, and so despite the fact that I was reunited with Elizabeth as my translator and thrilled by the fact, I really didn't see as many patients on my own because I spent most of the day “rounding” from one nurse to the next helping them decide what the best course of treatment would be for a particular patient (not that I always knew!). Everyone just worked so hard today and he hot, dusty, the mighty and extremely dingy building. So many things happened today that I doubt I'll be able to do the description justice so I think I'll just list them.

1. A hundred numbers had been given out early in the morning and so when we arrived there were some very calm and quiet patience waiting there was also a group that did not seem to have numbers in their hands. I actually thought that there was going to be a riot when the village representative came up with hundred more numbers to give it. There was grabbing and pushing and an awful lot of yelling.
2. An old “Bibi” was brought in sitting sidesaddle on a bicycle that was navigated by the middle-aged man
3. There was an absolutely adorable six-year-old girl with hydrocephalus. She had significant that cited weakness in post for her family. Her mother's main complaint was that she was becoming unable to carry the child anymore and was wondering if there was any kind of transportation that was a new poll. We've sent them to KC MC to get fitted for a tricycle, and we gave the mother the contact information for the center because we are going to try and fund raise to help her pay for it.
4. A 3-year-old girl was brought by her mother with lesions on her vulva. They were vesicular lesions is one looked herpetic to me. That's the kind of thing that would be reported to the children's aid Society in Canada, however the best I could do besides treating the child was to ask mom if she thought it was any chance that the child is paying molested. When mum said no, that had to be the end of that discussion since there really is no recourse for this kind of thing in this country. The child will be going to Kilema on Friday to follow up so hopefully I’ll be able to see her then.
5. A 35-year-old man came in with facial swelling in the mornings and bilateral swelling his legs. He has protein and blood in his urine and we think he most likely has nephritic syndrome. He will go to KCMC for investigations.
6. A 4-month-old baby was brought in with the fever. The child had a respiratory rate of 60 and a heart rate of 180. He had a bulging fontanel and was quite lethargic. We had to get a taxi to take them to Kilema for admission. The child is on Amp/gent last I heard.
7. I saw a Bibi with a huge growth extending from her mandible that had been growing for a year. A first, I thought it would be submandibular gland, but on palpation, I realized that it was very firm and seemed to be continuous with the bone. I think it’s a sarcoma. She will go to KCMC for ultrasound and biopsy.
8. At 5 we still had about 60 people in line. I thought that I could clear some people by asking if there was anyone who was well, but was only there for the free de-worming meds and Tylenol. I was pleased to see 12 people stand up, but unfortunately only 2 of them actually had charts. I wrote their prescriptions after confirming with the translator that they were well and just wanted the free basic meds. Then I began the frustrating task of dealing with the 10people who had been waiting all day despite the fact that they had been told repeatedly that they would not be seen without a chart. The KWIECO counselor, Mama Rutasa helped me translate and we decided that there was no way that we could see them because that would bring the other 40 people hanging around to ask for the same favor, and by then the group was about an hour and a half past their limit of capability. About 10 minutes after sending them on their way, one of the village representatives came and asked me if we could see the three people that he had been standing there with. She could not really tell me WHY these people need to be seen but she told me that they were the cooks who had made our lunch. I was getting really annoyed by the gall that she was portraying and basically told her, in front of the whole line of people who HAD chars, that we really appreciated them making our lunch, but that it did not seem fair to me to take them when we had just sent 40 people home who had been waiting way longer than them. I told her that it is her community, so if she wanted to take the responsibility of doing that, we would see them at the end…then they ended up leaving without even telling or thanking anyone…unbelievable!!
9. And then it happened: most probably the most emotional 30 minutes of the caravan (rivaled only by Elizabeth’s diagnosis)…Bernadette called me over to see a 9-year-old girl that she had just tested and the test was positive. I went over to talk to the girl and her 22 year-old sister (who was negative). The girl was fully developed and had had her period since the age of 5…very uncommon for any child but especially someone who supposedly had maternal transmission HIV. I told Bernadette that I really needed to know how this child got HIV and we started a convo with the patient and the sister…unfortunately, the translator at that station was a male, and I really sensed that we were not getting truthful answers. I told the team that I would go get Marietta (translator-par-excellence)…went to get her but as I was halfway through explaining the situation to her, Dharma came to get us saying he needed Marietta. I tried to explain that I needed her more but then he explained his need…Joelle, another Californian living in Tanzania that has been adopted by our group, had just got a needle stick from a patient that they were seeing and the patient refused an HIV test. I agreed with Dharma that that trumped my need for Marietta!! She went to talk to the patient to convince her, while I spoke to Joelle. The stick was low-risk to begin with since it was a lancet (not bored needle) and very superficial so when the patient tested negative, we reassured her that she did not need prophylaxis (a phone call to Chris F confirmed that decision). I then went back to the child and Rachelle (Agnes’ sister) had been translating and confirmed my suspicion…the child had been raped last year and when the family had gone to the police, the rapist had fled the area. We had a long talk with the sisters and concern was raised as to whether the sister would be able to get the child to Mawenzi clinic and whether her family would be supportive of the medical care that the child would need. The sister seemed very scared at the prospect of trying to get her there…especially on a monthly basis. I offered them a bed at the center but they said that they would come the next day. We gave them money for the dala dala and told them to hide it so that it could not be taken away for them.

As we left on the bus to go back to Moshi, I could not help the tears. It was a demanding day and the end of it really illustrated the atrocities that some people here face. In the bus, Vicki told me that her friends had opened a raped crisis center in Moshi in December and that they had helped 60 to date…30 of them under the age of 10!! We have a really long way to go.