Monday, January 13th - Sarah

This day was a national holiday. I believe it is to remember the day Tanzania acquired Zanzibar.  The HIV clinic here was supposed to be closed due to the holiday, but the patients were not aware and so they showed up anyway and the physicians staffed the clinic anyway.

Many patients have to travel very far to get their medications and so it was nice of the physicians to be open anyway. I don't think this would ever happen in the U.S. The HIV clinic is referred to here as the CTC clinic here in order to decrease the stigma. It stands for center for treatment and care. Many acronyms related to HIV are changed to decrease stigma. I was in the part of the clinic where the medications were given out. The patients would come in to our room one by one after seeing the physician and present their file and a medication card. The card had columns for the date, the date they were to return for another check-up and more medication, the medication they were to receive and the quantity. Most patients received one month's supply, but if they traveled from far away, they were often prescribed two months worth. The pharmacist would then sign the card, document the medication to be dispensed in a log book, and then dispense the log book.

We saw two patients in this setting who presented with serious skin conditions and we sent them back to the physicians to determine treatment. I'm not sure whether these patients had bypassed the physicians their first time through the clinic or if the physicians had made a clinical decision not to prescribe further treatment for these patients. Upon examination the Tanzanian physicians determined that one of the patients had leprosy and the other had a horrible case of shingles that left a deep wound that had gotten infected. The appropriate treatments were investigated, but I wonder if the patients will be able to obtain them. Drug cost and supply are difficult issues here.

In the afternoon, we visited the Ilula Orphan program where we were greeted by a group of singing girls. They sang "Karibu" meaning "welcome." We then signed the guest book and spoke with Berit, the Norwegian woman who started the program. After a concert by the girls which included everyone being pulled up to dance, we learned about all the additions that had been made to the program to improve the lives of people in the area. They grew crops and raised animals including pigs, goats, cattle, and chickens. There were areas for making shoes, sewing, welding, and carpentry. Recently a library was opened with lots of financial assistance from the people of Norway. The high school was very impressive with its comparatively well equipped chemistry lab and also appeared to be well respected. We saw a Lexus from Dar arrive to drop off a few children after the long holiday weekend.