God Save the Queen.

Although her actual birthday is April 21, for some reason, the international birthday celebration for Her Royal Highness, Queen Elizabeth was this weekend.  As we Tanzanians are part of the Commonwealth, we had a celebration here in Arusha although judging from this photo, we weren't wearing odd enough hats.. First was appetizers and drinks that were called Pimms. Very British, old chap. Then a wonderful picnic dinner.  There was live entertainment by local musicians who were all excellent. You haven't lived until you have heard the Beatles's I Want to Hold Your Hands sung with an African accent.  It was also a fund raiser to expand internet access for schools.  We bought two weekend getaways in the auction so I figure we put internet into several schools. We got weekends at what my sons would call kick-ass resorts. I would call them very nice resorts at a very nice price..  Google Four Seasons Safari Lodge.  We don't stay in places this nice. I think I could get used to this.

Children

I went on a bike ride with my brother, Erik. Now that was challenging mountain biking. At one point I lost sight of him on a footpath through a banana plantation and had to ask a pedestrian in my broken Swahili which way the guy on the bicycle took at the fork in the trail. Definitely not like the limited mountain biking I have done in the US. A great part of mountain biking through the countryside is all the kids. Riding a bike makes for a whole different connection to the community compared to driving a car.  The older school children are more reserved, but the little ones want to show off their English. It is always the same thing. "Good morning. How are you? Do you think Bernie Sanders will get very many super delegate votes at the convention?" OK, I made up that last sentence, but they are still very cute. Greeting us in English, waving, and a great big grin on their face.

The medical team

The diseases I am seeing now are quite different from what I saw in the US. Some are due to poor sanitation. I have never treated neurocysticercosis until I got here. It does exist in the US, but it is very rare. Some diseases are related to being in the tropics. I treat as many patients for malaria in a week here as I did in over three decades of practice in the US. (I saw one case of malaria in my medical residency and then never again.) Arusha is located at 4,000 ft on the foothills of Mount Meru so it is a bit too cool for the malaria mosquito.  We don't see as much here as in other areas.  Some medical problems are related to poverty. Typically people wait until they are very sick before they present to the hospital. A common scenario is a patient coming to the hospital with a 3 month history of diarrhea and two weeks of vomiting.  By the time they get to the hospital, they are emaciated. I have never used children's blood pressure cuffs on adults before. I do this on a daily basis here because of so many extremely skinny arms.

In the US, AIDS is treated by AIDS specialty teams for inpatients and outpatients. While there is an outpatient AIDS clinic here, when the patients are admitted to the hospital here with a complication of AIDS, I treat them.  In addition to triple drug therapy for the AIDS virus itself,  there are medications used to prevent infections depending on the CD4 count. There are also additional treatments for actual infection complications. A normal CD4 count  is often above 1000 and definitely above 500. Getting down under 200 is a high-risk situation. Just this week, I saw a patient with a CD4 count of 4. There are a variety of misunderstandings and logistic reasons that people end up not taking their AIDS pills.  

There are few functioning sinks on the medical words. So much for hand washing. I go through a pocket-sized bottle of hand sanitizer a daily basis. There are only multiple patient wards. There are no isolation rooms. TB patients are put next to the window in hopes that the bugs go out the window instead of onto the other patients. I am definitely going to get checked for AIDS and TB when I get back to the US.

The photo shows the medical team including an American resident here for one month and the Tanzanian Assistant Medical Officer.  An AMO is like a physician assistant in the US.  She has her hands full filling all the gaps in my medical knowledge.