Monday in Moshi: Cleaning up from the Immigration Fiasco

Monday the 28th April
Although I would have loved to race around town with Karen collecting signatures, making local contacts for the times that I am here without Karen and dropping off documentation so that we could open our doors to patients, I was more needed at the center. I took on the role of leading the medical team and getting people ready to be able to start treating patients as soon as we got the phone call that the last paper had been delivered where it needed to be. It was an interesting day to be in charge. Nothing was “usual”. Firstly we needed to decide how much we could do with patients without being seen to be “treating” them. We decided that registering them and doing their blood pressure and vital signs would be fine. As the group started to do that, Vicky got a phone call that a center for underprivileged girls wanted to bring 60 girls to be tested and examined. After developing the game plan for that, and after the girls arrive, it of course started to rain! The volunteers who came with the girls were great. They shuffled them from one place to the other and manage to keep them dry. The girls seemed to come in two sizes. I'm not sure where the 8 to13-year-olds were, because basically they were the “little girls” who are anywhere from three to eight years olds, and the “big girls” who were teenagers. While we tested the little girls and examined them, the HIV counselor took the teenagers in two groups of a dozen and counseled them about HIV. The little girls seemed relatively healthy, although one of the astute nurses who was examining them picked up a very irregular heart rate on an eight-year-old. The patient had not really expressed any complaints, but when we questioned her, she said that she had been febrile the week before and had missed school. We ended up referring her to have an echocardiogram and in the meantime we treated her for strep, in case she was having some sort of myocarditis or rheumatic heart disease. Thankfully, none of the girls was HIV positive. Once we had finished with the little cross we moved on to the big ones. They had finished their pretest counseling and they'd been lined up to have their tests done. It did become a little bit of a shambles for a moment as all of the girls were standing around with their tests in front of them. We eventually got them separated and were able to tell them the results one at a time, and they were all negative as well. Again one of the wonderful nurses with whom I've been working for the past two weeks, picked up a serious illness. One of the teenagers was complaining about headaches and she did her blood pressure and found that the 16-year-old’s pressure was 140/100… dangerously high for anyone but especially someone of her age. She did not seem to have any signs of coarctation, and so the highest on the differential was that there was a renal cause. The teachers told me that there was no way that she would be able to go to the hospital as the cost would be too great for her very poor parents. I stressed that she needed to be investigated as soon as possible, but because she did not seem to be able to commit to being seen there, I decided to treat her hypertension in the interim. Shortly after dealing with that, I had the “pleasure” of meeting, and having to deal with, the optometrist who had called the police on Friday. Karen had invited her to come and help on the caravan, not expecting that she would take her up on her cough. She showed up and started a whirlwind of activity. I introduced her to the young girl with high blood pressure, because her main complaint had been one of difficulty seeing the blackboard. The optometrist (no-not an MD), began questioning my judgment in a very condescending way. I stayed calm and explained the situation to her, which just made her spin off into another correction. I managed to get her into a room where she could set up to do eye exams, which got her away from anyone else who might have to deal with her. The most irritating part about the situation with that woman is that she then ASKED TO BE PAYED and we gave her 30 000 TZ shillings (30 dollars) for her assistant to stay; we told her that she could leave!! Just as we had dealt with her, two of the immigration people came back but were unable to tell Abbas why they were there. I knew that they had been asking about obtaining medical care on Friday, so I figured that that's why they were here however they didn't manage to convey that to Abass. It turns out that they WERE just here for care (unbelievable nerve, if you ask me, after everything that they had done to the group 3 days prior) but their presence certainly increased the nervous energy around the center for a few minutes!! The rest of the day went very smoothly, and we even avoided making 40 orphans travel half an hour to come for testing… instead I did a draw to choose which two people would go to the village to do the tests. I think that they had a real eye-opener. Among the stories they brought back, one that really stuck in my mind fact that last year the food budget ran out after just six months and so the children ate rice and nothing but for six months. I can only imagine how malnourished they must have been.

There are three other patients that I would like to remember from that day. One of them was actually a patient of Wendy's. He was an 18-year-old generally healthy boy who came in because of a cough. As with all of the patients that we've been seeing, she suggested that he have any HIV test. She told me afterwards that she had absolutely no suspicion that it would be positive and so when she saw the two strips she was mortified as was the patient.
There was also a 10-year-old somewhat chubby boy who came to the center stating that this he lived on the street and had run away from home because his stepmother beats him. Krista and Penina had a long talk with him and felt that they were some definite inconsistencies with the story (including the fact that his chubbiness certainly went against him being starving). He also gave a history of being choked three days prior when he was stealing food. He said that he was unable to swallow. We got him since he and cupcakes and he managed to get those down (!) and arrange for him to go to social services the next day. Later that evening Otto told us that he knew the boy well and that's key did, in fact, live on the street because his parents just couldn't handle him anymore. The final patient that I want to talk about from today was a 19-year-old woman who came in six months pregnant. She told Agnes and I could she was living on the street and had nowhere to turn. She tried to get help from her mother and from her grandparents but they had all turned her away and told her to go get help from the man who had made her pregnant. She had tried to find her father but was unable to. The last she heard he was living in Dar. She had been working as a cleaner in a hotel but as soon as her belly started to show, that they had fired her. She said that the man who had impregnated her had been the one who found her the job. He had expected her to have sex with him to thank him for the job. As we spoke with her, Agnes and I looked at each other and we both knew that this young woman epitomized the perfect candidate for the center. We found her some shoes and some clothes and took her into the center to get settled. Once she has some rest and food in her belly, Agnes and Vicki will help her find a family member who is willing to help her. She will go for her first prenatal assessment at Mawenzi tomorrow.
Speaking of residents at the center…an update on the “crazy woman” is that she has picked fights with the other resident every night, she drank the baby’s formula, she even tried to fight with Babu (the elderly handyman at the center)…so she is gone. Agnes took her back to social services, thanks goodness!!

After the day at the center, Karen and I went with Otto to see his house. We've been considering renting it to have as housing for medical students and anyone else who comes to work at the Center. It's lovely. There are two bedrooms, a living room and charming backyard. It is certainly not extravagant, but it'll be a nice pied-a-terre for the students. We negotiated many things with him, including painting the house, finding its furniture and a stove and coordinating with the “dada” (sister/housewoman) working for us. Once that stuff was out of the way, I told Otto that we liked him and trusted him and he felt that he was part of the family, and because of that we wanted to give his number to all the medical students who came to town so he can be their main transport guy. Otto has been acting as a driver for us while we've been here and for CACHA members in previous visits. Because we're close to him though, it's really quite difficult to negotiate prices with him, and therefore I, for one, have been paying him far too much for the rides he has given us. I suggested that we negotiate a fair price then and there so that the students would not need to do that with him in the future. He was very open to the suggestion, so we now have things on paper and they know that he will take very good care of our students when they are here.

The “Victoria ladies”, as they are now known, Karen and I went out to dinner at the Salzburg. It was a lovely dinner, and I went to bed at peace after a satisfying day.