1/17/2015 - Astrid

Everywhere I turn, I see beauty.  I wake up every morning thinking about what the day will bring. The minute I step out of my dorm, this is what I see:

*can't seem to upload a picture here. Imagine a beautiful scene... a beautiful valley with great seemingly blue mountains in the background. Simply breathtaking*  Oh! Here it is!

I have been learning so much these past few days. On January 13th, I had the opportunity to spend some time with Emmanuel, Ilula Hospital's laboratory technician. He graciously offered to show us the hospital lab and took the time to teach us about the Malaria parasite, P. Falciparum, its life cycle, and the diagnostic tools available to him. It was fascinating! I looked into the microscope and there it was right before my eyes: A seemingly harmless and microscopic organism. This parasite kills hundreds of thousands of people each year. As fascinating as it was to learn about this parasite and its interesting history and evolution, I often stopped to think about the suffering that it causes to millions of people each year. The book, The Fever: How Malaria Has Ruled Humankind for 500,000 Years, has answered many of my questions but raised many more. I often wonder if we will ever come up with a vaccine.  In the meantime, we will continue to look at blood smears under the microscope to determine if someone is infected so that they may receive proper treatment.  Emmanuel also discussed the use of a malaria rapid test in the initial diagnostic process. 

In the following two days, we spent some time in the lab with Phil.  We learned about some hematologic disorders and had the opportunity to use the microscope again to observe different cytology samples that included cancers such as CML, CLL, and AML. We also observed samples showing schistocytes, sickle cells, and "cookie bite" red blood cells resulting from G6PD deficiency.  Randy showed us sample smears of Anaplasmosis and Babesiosis.  This experience could only be described as AMAZING.  I did not expect to learn from hematologists/oncologists.

In the past week, I have been lucky to get to know the local people and my colleagues better. I do need to take a Swahili class. I would love to hold conversations and learn more about the culture, the stories… everything. The pharmacy students and I have been discussing residency opportunities, interviews, HIV medications, infectious diseases, antibiotic therapy, among other topics. It changes all the time. I am learning so much from them. Seems like I was in school just yesterday (I did just graduate), and yet there is already so much more to learn about - new guidelines, new drugs, new everything. Keeps me on my toes. It has been very interesting to compare the different guidelines from Tanzania , WHO, and the US.

I have also spent time exploring the town of Ilula and Iringa with others. Today is actually our second time visiting Iringa. Such a wonderful place!  I have much more to tell you all about. But, it is time to go. Until next time. 

Siku Njema! (Have a nice day!)

1/9/2015 Steve Clappier

After two long 8 hour plane rides, the group was very excited to get out of a plane and see Tanzania. I wasn't super excited that we had to endure another 9 hour bus ride to Ilula but we got to enjoy some awesome sites along the way! My favorite part of the bus ride was getting to see the wild animals from the bus. We drove through a national park. We saw gazelle, buffalo, giraffe, and elephants. 

One thing that I didn't anticipate is how green Tanzania is. We are arriving at about the time of the rainy season. The bus ride was beautiful  and took us through the countryside of Tanzania. 

When we arrived as Ilula we had a host of people to welcome us. The hospital is in a beautiful location overlooking green fields with some rolling hills. We are all very excited to start clinical care and see how things are done differently here. 

We hope everyone is doing well at home and look forward to sharing more stories with you!

- Steve

Progress at Ilula!

As this is my fourth journey to Ilula I have to say that it is incredibly inspiring to see progress.  The first item to note is the road in Ilula is paved!  All the way from the highway to the hospital.  Randy and I did both note that a little bit of the ambience of Ilula was lost but of course it is best for patients and staff of the hospital as well as villagers.
The second bit of progress was the new Pharmacy Technician:  Gift is a Tumaini trained technician that assists Frank in the CTC with HIV medications and other functions. Frank truly has much documentation to care for as the medication management system is entirely manual; Gift is truly a gift!  They both hope to recieve training to electronically document anti-retrovirals- they have a computer and software and await the education.
The third piece of inspiring news is medications are listed on the back page of the chart (similar to our "blue books").  Although this is not a MAR per se, it is documentation that I have not seen before.  We still struggle on rounds to understand if the medication was administered or not but minimally a list is helpful!  Meds are documented in a separate notebook at the nursing station as nurses draw meds up at the station and document at the same time.  We have sadly seen many cryptococcal meningitis patients for which there is no medication available on campus.  At Ilula the drug of choice is fluconazole and the hospital is out of stock.  Patients families can buy the drug outside the hospital walls but it is $30 a day- this in a country where the average annual healthcare expenditure is $20/year- a significant problem with challenging solutions.
Finally, it is inspiring to have Astrid returning and teaching.  We sat down for 3 hours the other night and put together HIV medications 101- adults only- just information that you need to get started.  It was very helpful to both of us and we will give the lecture in the next day or two.  Emily, Sarah and Grace have all participated in a mobile clinic in the village.  Next couple of  days will bring Malaria Meds 101- DPQ is a second line agent here and we can all review.  I also hope to interview Frank Sanga the pharmacist along with our students- if I can get my technology to work I can show the video to pharmacy students.  Technology challenges are not trivial- at the present time, internet is not functional at Ilula and electricity is out on campus- we had a big storm last night.
Safari Njema to all of our second-half colleagues!  Jill

Mark 1/14/2015: HIV Clinic; Joy and Grief in the Maternity Ward

Another fascinating day at Ilula hospital today.  As the only psychologist in our group, I have been looking for ways to plug in. The mental health needs of these patients seem to be immense from my perspective as US trained MH clinician, yet everyone seems to get by despite great hardships.  Today, I helped out with the HIV clinic; we saw over 50 outpatients in about 5 hours.  I have not had much exposure to HIV, but after less than one week in this hospital, I have a much better understanding of the disease and treatment options, thanks to the pharmacy staff and MN students that have been so helpful in explaining the complexities of HIV drugs available in TZ.  The mental health status of these patients is across the board, from withdrawn and sad to upbeat and smiling and grateful to have the drugs. Attached is photo of Grace and Astrid with one of our happy patients. 

Grace, a new friend and Astrid

 The patient that stands out for me is a 45 y. o. male who presented with a stocking cap drawn over his right eye. He removed his cap and told his story that he lost his right eye about 4 months ago due to an abscess. There was disfigurement around his eye-socket and discoloration of his skin above around the eye-socket and right forehead, not a pretty sight.  He saw that I was wearing glasses and inquired if he could get some glasses to help his vision with his remaining eye.  Anita, the TZ medical officer prescribing the HIV meds, did not know what might be available to him.  My impulse was to give him my glasses, thinking this patient is struggling with vision and obvious body image issues. I don't need these glasses, and this was the least I could do to help him. But I knew that would not be best... a feeling of helplessness and frustration came upon me. Anita was kind and supportive to him, and he seemed appreciative when he left. I hope he can get those glasses somehow.

Here I come!

Right after seeing this patient I was pulled to OR to observe a C-section, my first ever.  C-section seem to be more common here than in US.  Ilula hospital is fortunate to have an updated OR and it is a busy place.  A healthy baby boy was crying within a minute of coming out.  Brought back to me fond memories when my first son was born 27 years ago.

Ten minutes old

Tomorrow,  I will do rounds on the maternity ward.  Dr. Saga has asked that I provide counseling to a 35 year old woman who is 28 weeks pregnant. She is identified as a "precious baby" patient. This is her 11th pregnancy.  All prior 10 pregnancies have not been successful. Today, an ultrasound revealed that there was no fetal heartbeat.  Jessica did great presentation during case discussion this afternoon as to reason for her failed pregnancies.  We have lots of questions as we don't know her medical history clearly - no EMR here.  We will share with her the news of the ultrasound and do what we can to help her work through these major grief and loss issues. Sure wish I could speak better Swahili.  

Mark

Mark 1/12/15

As an Ohio State graduate, today started out at 5 am as this was THE day (night for those of you back home) for the national championship game - Ohio State vs Oregon.  I made my way down to the "internet room" with my headlamp on.  I sat in this dusty room with old Compaq computers, following the game on game tracker.  Two hospital employees showed up about 7am and I tried to feebly explain American football with hand gestures.  After the  Buckeyes were victorious, I ran back to our lodge, giving high fives to everyone  and quickly changed clothes in time for 8 am devotions.  

Ohio State vs. Oregon and Ersatz Alums

 Later in the afternoon we had a big happy hour gathering with Professor Paul [Strykowski] and his engineering students from UMN, who were assessing  water capabilities of the hospital campus.  Attached is celebratory photo following our happy hour.  Theo, Emily and Sam  graciously agreed to be Buckeye fans for the day - the photo will inform you of the score. I think others from the group will be back to the internet room on Sunday night to follow the Packer game,  Kwaheri!

Jenna 1/10/15

Today was our first full day in Ilula. Because it was a Saturday, there were 2 options for people to work in – 4 people went out to a remote village for an HIV clinic and the rest stayed at the Ilula Lutheran Hospital for group rounds. We were all a bit overwhelmed by the experience – these patients were so incredibly ill and there seemed to be very little that we could do. We saw kids that were malnourished, one child who was edematous all over and presumed to have nephrotic syndrome, women with eclampsia and men with crytococcal meningitis/AIDS. We had time to debrief after the first day and discussed medical culture shock as well as our emotional responses to what we had seen. Whenever we had downtime, or were in the bus, Randy (Dr. Hurley) would teach us about common topics based on the cases we had seen earlier that day. I appreciate all the teaching that our attendings are doing here – and our trip has just begun! I look forward to getting to know everyone better, continue to learn about medical care in Tanzania/developing countries and to hopefully learn some Swahili!

In the evening we went to Pub La Monte where we had a Kilimanjaro beer and played with a few kids who were in the area. Emily was taking pictures with them, and they squealed and giggled when she showed them how to take a “selfie!” Such sweet people here.

Jenna Clappier

Oh the Excitement…

I imagine the students and faculty are settling in at Ilula, getting accustomed to their new home for a month.  Astrid has been kind enough to receive my texts with generosity.  By now I may have reached the nuisance level.  Randy uses his iPhone email, so I hope that is via Wi-Fi at Ilula and not cellular data!

Sadly, the crew needed to get new SIM cards for the phones – out of use too long.  I have posted them above, but will check to see if they work.

We have a $100 donation for the Good Samaritan Fund that I will carry to Ilula.  (Thanks Bob and Mariel!)  This is a contribution to the hospital for patients who cannot pay.  People over 60 or 65, children birth to age five and pregnant women are covered by the government.  Many Tanzanians do not know this.  However, that still leaves many who have no ability to pay for services.

Dear Readers, I would be remiss if I did not tell you how and where to make donations if you wish!  This blog is not intended for fund-raising, still….  You could send donations to:

Shoulder to Shoulder

1430 Appaloosa Trail

Eagan, MN 55122

Undesignated funds are welcome and most flexible.  Or consider Ilula Nursing Scholarship, Ilula Good Samaritan Fund, or International Medical Conference.  Just write it in the memo line of your check.