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.