Caravan in Kilema

Tuesday was a caravan day in Kilema, which was perfect timing for me so that I could check on the kids. They seem to be doing great!! They are behaving and playing really well with the other kids.
The caravan was really nice, too. The facilities are head and shoulders above places like Himo, and we had great translators, because the clinical officers are around and helping out periodically. Unfortunately, I did not get to work with the wonderful Julius, who was a great translator on the caravan last year, because he was busy in the hospital…but I worked with Agnes and others which was great.
The one thing about working in Kilema and Himo is the RC influence. It is really hard to feel that one is doing everything necessary for your patient when things such as condoms and birth control cannot be discussed. One of the huge improvements in the CACHA caravan, in my opinion is the fact that we can do HIV testing now (and we offer it to every patient). It is really difficult though, to be in a place where we cannot talk about or give out condoms…something that we will have to think about a lot before we plan the next caravan.
The two patients that stick in my mind form today are 1. A beautiful 12 month old girl who had been on antibiotics for 5 days for a pneumonia who had begun vomiting and was extremely lethargic. The thing that stuck in my mind was the ultimate caring, affection and concern that the father was showing. It made me realize that we usually see the moms or bibis, not the dads and even when the dads are there, they are usually quite stoic about the situation. This guy seemed like an awesome dad. 2. The other patient was an 18-year-old girl who was physically developed appropriately for age but who had not had her period yet. She described a couple days in December and a couple in January when she had crampy pain, but no bleeding. I fully expected to see the second imperforate hymen of my life, but the examination was not classic. Reza, the ER resident from UCLA who has pretty much joined our group in the last couple days (he is doing a rotation at KCMC but spending most of his time with us) has a portable US machine, so we looked for a big uterus but did not find one. She will come back tomorrow for a formal ultrasound with Dr Masawi and Chris will follow-up on the results.
All in all, the day was good, and although it was hard to leave the kids again, they both declined my offer to take them to Moshi!! They are having a great time!