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.