Hospital cases

Working at Selian Lutheran Hospital is an amazing experience. Some days, I would replace the word "amazing" with "overwhelming." I have enormous respect for the medical staff I work with here. They work in a very limited resource condition without getting discouraged.  I have been impressed with the quality education they get in their training in Tanzania.  I work mainly with doctors-in-training, but also have interaction with the other staff physicians.  They have a sound understanding of the science underlying the practice of medicine. In addition to knowing how to use their local tests and treatments, they also know about tests and treatments that are not available here and sometimes anywhere in the country.

I see monthly statistics only for the limited time I am here.  The death rate is down 30% this year on the adult medical wards compared to last year. I can't say what is causing the difference.  I don't take credit since I was not here for most of the first 6 months. We still see bewildering problems.

I recall a dramatic case last year of a patient feeling sick and consulting the local herbalist, a common practice. He took whatever the herbalist prescribed and becoming comatose in 1/2 hour.  He was then brought to our hospital.  Since we didn't know what was in the herbs and have no toxicology testing available, our only treatment is supportive care and waiting for the liver to detoxify the body. That patient never woke up and ended up dying. We recently had a nearly identical situation occur.  This time, however, the patient woke up three days later with all vital organs intact and ultimately walked out of the hospital. Herbalists, by the way, are not witch doctors (who do exist in the Maasai villages, but are a different type of practitioner). Herbalists have learned from their elders how to use local plants so it is knowledge that is passed down through the generations. We only see their treatment failures and they don't publish placebo controlled, double-blinded clinical trials of their products in the New England Journal of Medicine, but they must have some successes or they would not have any customers. There are researchers, medical anthropologists, who study the herbs used by traditional herbalists to look for therapeutic pearls there that can be incorporated into western style medicine.

Speaking of traditional health practitioners, there are also traditional birth attendants who attend most of the deliveries out in the bush country. They have learned their art from older birth attendants. There are not nearly enough obstetricians and western medicine trained midwives in the country so the traditional birth attendants provide a valuable service. I recall visiting a Maasai village, by coincidence, where a baby had been delivered the night before. The traditional birth attendant didn't live in that village, but was fortuitously visiting her relatives.  The labor was not progressing so cow's cream was given to the mom to try to stimulate labor. When that didn't work, the attendant decided that the problem was a transverse lie; the baby was sideways.  She performed an abdominal massage to rotate the baby head down and the baby was born without further difficulty.  Without that intervention, both mother and baby would probably have died.

We recently saw a woman at Selian that had strange symptoms.  She complained of numbness and weakness in her arm and leg on the right, but didn't really have  demonstrable abnormalities on exam.  Things were not right, but it wasn't clear what was going on. She also had a strange thing about her scalp.  It was spongy like fluid under the scalp. We asked to have a CT scan of the head done which is a big deal since it is very expensive for pastoralist Maasai and involves transporting the patient to another hospital where they have a CT scanner. That revealed a 9 centimeter in diameter meningioma, a tumor of the membrane wrapping around the brain.  It had eroded through the skull so there was leakage of cerebrospinal fluid underneath the scalp.  Never seen that before. She was referred on to the neurosurgeons who are unfortunately far, far away in Dar es Salaam.

Adult medicine in the right side of the building and pediatrics on the left.
The ground has a purplish cast to it due to the fallen petals from the large jacaranda trees in the courtyard.

Medical lecture in the cafeteria.

Arti, the woman in blue, is from the University of Minnesota which sends out Chief Medical Residents from their Global Health Department. They come out to be teachers and also to get more personal experience in tropical medicine.

Don

Debi's entry. Cyclists, money & food and other anecdotes.

Last week Erik and Bernice were both gone all week on business. We wanted to have Nashesha over when we got her all to ourselves. She has such a busy social schedule that we finally got her on Thursday, but she said she had cyclists and wasn't sure we wanted to invite them too. We said SURE!  We love meeting her friends!  I told her I was making a big pot of spaghetti sauce and there would be plenty. (More ripe tomatoes to deal with!)

Turns out, these were not "friends" exactly. They are members of an international biking club and when near another member, they make contact and get a bed and a meal or two before resuming their trek. Don picked them all up st Nashesha's house and I was surprised to see 40 year old adults come through our door!  I was even more surprised to learn they are from ITALY....and I was serving them spaghetti! We offered them wine and beer and cheese and crackers before dinner. They acted like they were in the lap of luxury eating at the Ritz! 

They took out a laminated map of the globe with their route outlined with a magic marker.  We were astonished to see that they have bicycled from Alaska to the tip of South America, and all over East Asia and Australia and are now making their way across Africa!  They carry their tent and supplies with them and when going through a desert, 20 liters of water each!  I felt like we were accidentally in the company of world class explorers!  What an enchanting, memorable evening we had!  And there is nothing like feeding campers for getting compliments on your cooking!  

A word about money here. One US dollar equals 2230 shillings. The numbers are so big when buying things that an easy estimate is to drop the "thousand" and divide it in half. So 10,000 shillings is approximately $5.00. Wages are very low (we pay Mebo 10,000 sh/day and she is happy to have the work since so many are unemployed) and prices tend to be low too. I can buy 26 long stemmed roses for 5000 sh. They don't last as long as in the US...a week at most, but they are 10 cents apiece!

It is easy to take on the norms around you. So many people watch their pennies and do without anything other than the necessities. It is also easy to start thinking of 5000 shillings as $5.00 (instead of $2.50) since in the US the price would be easily be that much. I found myself wanting to buy a wider roll of aluminum foil since I would struggle to wrap a loaf if bread or cover a cake with the foil that came with our rental house. The wider roll was 6000 shillings and I thought that was a LOT so I did not buy it. Next time I struggled with my foil, I realized I was agonizing over a $3.00 purchase!  

Food costs are just amazing. Everyday vegetables (tomatoes, onions, carrots, cucumbers, green peppers, potatoes, green cabbage, eggplant) are very cheap.  I just bought a kilo of tomatoes for 2000 sh which is like 25 cents/pound. I bought this at a vegetable stand and I bet Wema's mother could have done better. A huge pineapple (and better tasting than anywhere) is 3000 sh. ($1.50) Also, we have a garden so I can pick lettuce, spinach, Chinese cabbage, all kinds of herbs in addition to free avocados from our trees. We have three different kinds. Incidentally, the avocados are the size of 4 at home and one is 500-1000 (25-50 cents!) if you buy it. I make guacamole regularly and it costs very little. The chips to eat it with seem expensive ...7000 sh, but I have to remind myself, that is not $7.00, but just over $3.00!

Meat (I use the term broadly to include fish and poultry too) is another interesting thing. Now that I know where to go, I can find beautiful meat. The cows here are skinny by US standards and the beef tends to be very lean and tough. Linda warned me about this and said the hamburger is actually very tasty and more tender.  The mince (hamburger) is so lean that I add a little oil when browning it!  There is almost no fat!  The color is pure red. When I make a meat dish, I buy two kilos of round steak which is cut in cubes.  Again....pure red....no marbling. I put it in the crockpot for 24 hours!  It has wonderful flavor and it just falls apart. Linda does hers in the pressure cooker but I am afraid of using that. The cost seems very high....most people eat meat twice a week because of the expense. I assumed it was terribly expensive because it is priced at shillings/kilo, but I just realized it is $3-4/pound!  When we serve chicken or beef it is usually in a sauce mixed with vegetables over rice pasta or potatoes. The Tanzanians, especially the Maasai, just love beef. 

When we eat at a restaurant, the food is really GOOD!  They use spices so well. I would say the food tends to be spicer than in the US overall. There is a huge Indian influence. The bill is almost never over 15000 sh apiece....$7.00. Tipping is not expected. At really fancy tourist place like the upscale restaurant where we ate last night was 130,000 which included wine, appetizers, two dinners and two deserts!  ($58.00) That was a splurge!

So, it is not expensive to entertain at home  or socialize in restaurants here. That is a huge plus. Wine and beer are also interesting. The beer is really good. We don't drink beer anywhere other than here. It comes in 500 cc bottles for 2000-2500sh. ($1.00). Wine comes from abroad, mostly South Africa, but also Australia, Chile and New Zealand. It is not of Walla Walla quality, but some is not bad! I pay 13000-20000/ bottle (I just did the math...$6-9!  Jeepers!  That is less than I thought!).  See what I mean about thinking of sh as dollars?  Soft drinks in a reusable glass bottle are 400sh (18 cents!) and a 500cc plastic bottle is 1000sh, but then I have to recycle. 

Ok, on to other stories. There are so many!  What to choose?  I will start with this one:  we recently got a fancy invitation to an event at Selian Hospital where Don works. Our invitation came hand written to Dr Rowberg and wife on the envelope. This was billed as a "Celebration". The Bishop of the Tanzanian Lutheran Church would be present to celebrate the transition from government involvement to independent control. Truly, I am not sure if that was the purpose or just that they needed money and planned a big celebration to raise money. There is so much I do not understand!

So, we skipped church and raced to arrive for the 10:00 beginning. We parked the car, raced to the courtyard where tents and chairs were set up only to find NOT ONE PERSON in the chairs!  Once again, you just have to laugh!  We were on Wazungu (white people) time. 

Debi (in the shadows on the right) and one other person seated at the 10AM start time.

We had also been informed ahead of time that the medical staff was expected to contribute money to the effort. It was made known that the head Tanzanian doctor was going to give 300,000. The expectation was communicated clearly that everyone should follow suit. Can you imagine???  People in the US would revolt!  Not here!  A doctor who could not attend gave us money to contribute to give on her behalf. She warned us that we would be expected to say over a microphone how much we were giving!

On the way there Don said he would like it if he contributed 300,000 and I contributed 300,000. ( We feel so rich and humbled by the generosity of Tanzanians...300,000 is HUGE on their salary). I thought about it and told him I was thinking of following him to the microphone and announcing that I would give 400,000!  Don jerked his head toward me and said, "WHAT"?  I said, "Never mind!  I got the reaction I was hoping for!"  😄😄 

That day we witnessed Tanzanians contributing 5000 and 10000 sh notes along with money for auction items like a live goat on a leash. Altogether $62,000 was raised!  It seemed like the miracle of the loaves and fishes! (Don's editorial note: There is one difference with our experience and the biblical story.  Our group all got up and danced in the aisles in celebration.)

Anyway, while sitting in those chairs waiting for the celebration to start, I looked down at my legs. I was wearing a dress and my bare legs were exposed. My skin looked so WHITE!  I looked at my legs thinking, who do those belong to?  Who is the person wearing white stockings!???

It reminds me of another funny story...when the boys were all at home and growing like weeds. They all wore size 13 tennis shoes. I was used to dealing with left over belongings cuz we had a pool and the kids were always leaving towels and other things behind. One day I looked at all the shoes in the laundry room and saw these small tennis shoes. I wondered what child left them. Then I realized they were MINE!

That is exactly how my white legs looked to me that day!  I don't know how to better tell the story of culture shock....whether we are raising teenagers or going to the third world!

More stories will come!  I can't  do more at this time!  As I write, the Rowberg family campout is starting. I hate to miss it!

❤️Debi

Debi entry. visiting Wema

We have crossed the two month dateline. I am happy to report we are both doing better in every way. 

Don's hearing MUCH improved, but is not yet back to baseline; he will see the ENT specialist again on August 26. I think I am over my original respiratory trouble and I had ONE day if being Kleenex free before coming down with something new!  I don't know if this is a dust allergy or a new virus!  I am coughing up new stuff and it cost me a night of fun last Friday, but I am better....and I am sick of being sick...if not sick, not well either!

As far as adjusting to the culture shock, I think it is amazing that in such a short time one can adjust to so many things that are unlike home. Now it is the dry season and our windows are always open. Each day my IPad is not just covered with dust....it is dust mixed with sand. Funny how that begins to seem normal. You get used to litter...terrible, disgraceful litter. I understand the new TZ  president wants to combat this and declare every last Friday "clean up day".  A great start...Trouble is, where will it all go without a collection system?  Traffic remains a daily challenge, but even that starts to seem more normal.  I love being the driver for new visitors to TZ. They gasp and cry out helpful suggestions which makes me feel accomplished and confident in comparison. 

Last night was an exception. We had a near miss. Drivers are CRAZY here!  On a curvy road we met head on with a car in our lane passing several cars on blind corners. When I saw his headlights coming at me, I veered left, but there was also a bicyclist to avoid. How I missed both of them as he squeezed in front of me to his lane, I will never know!  All three of us in the car needed some recovery time. I am glad once again to be alive!  

The BEST experience for our little group of visiting medical people was to visit Plaster House. Somehow we never got there last time but are so happy we got to visit this time. For more information on this inspirational place see their website:  www.theplasterhouse.org. 

Again, the visionary, Mark Jacobson, realized that the healthcare system was missing some of the most vulnerable and needy among the regional population. Somehow it seems only logical to me that if you are able to provide care and treatment to society's most deserving, they will come!  Not so!  There is too much fear of a healthcare system and all the unknowns and expense involved. It is incredible to me that the way the staff finally got referrals was to go to schools and talk to school kids about the miraculous treatments available. They would show pictures of kids with club feet, cleft palates, severe bow legged ness from fluorosis and severe burns and ask, "Do you know of anyone who suffers from any of these conditions?"  Kids would recognize these afflictions amoung their siblings at home!

Nine years later, plaster house is the most amazing facility able to treat some of the most severely disabled children!  Just a simple cast is a challenge to care for in a cow dung hut which is home to the Maasai!  It did not take long for professionals to realize a residential treatment center would be necessary to treat the toughest cases.  Many children come in so malnourished (with hemoglobins of 3-5 when normal is higher than 12!) and with such complex medical needs that they require therapy and food prior to corrective surgery. 

We saw a clean, rather modern, peaceful, attractive facility where everyone helps everyone else and a place where the most disabled are not alone. We witnessed an impromptu soccer game where kids, using various assistive devices, were amazingly adept at moving the ball around!  One boy's foot was so severely deformed that he was running on top of his foot!  He was obviously getting pre-therapy and surgery was in his future. 

The burn cases were the hardest to see. We have seen these cases before, but I don't think we have ever seen so many in one place. Two people were so scarred that their faces were hard to describe. They looked like what Halloween masks try to portray!  My stomach did flip flops and I cannot think about them without a visceral reaction. Imagine trying to live your life with that kind of deformity!  

Plastic surgeons come from the US twice a year and do amazing reconstruction on these victims. Orthopedic cases and other reconstructions can be done by the general surgeons (who have extra training) at the hospital system where Don works. Mental health is pretty nonexistent in TZ, but the work done at this place is nothing short of life changing and transformative. The coordinator realizes that kids come in SO damaged by their disability that part of the care is to rehabilitate their inner being. Sometimes this takes years.  

I am SO grateful to the US and Canadian doctors who work here full time and for the visiting US plastic surgeons who do miraculous work on their "vacation"....many were Mark Jacobson's classmates!  Also, I am grateful to the mostly US sponsors of these children who contribute money each month to sponsor one child. They treated 700 kids last year!  Just astounding!

Back to other news...our daily routine is that Don gets up and goes to work and I stay home and do whatever.  I do not yet have a niche other than hospitality. I brought all kinds of improvement resources out with me, but so far no one has asked for my help. I am still overwhelmed by all the cultural differences that I would not know where to start!  Maybe by putting tape on the floor so people would know to line up?  😄 Of course it would take a Tanzanian leader to think this is a good idea, etc. I am hoping Tanzanians will be interested in this kind of work and I could be a resource for them. 

In the meantime, I have "get togethers" of various kinds with various people.  Sometimes it is snacks on the patio, sometimes dinners and sometimes picnics. I can find the most amazing food now that I know where to go, like frozen raspberries and Pacific Northwest salmon!  I am trying all kinds of spice blends. One if my favorites is a called  chicken masala. I plan to bring back a container of Chicken Masala when we return.  it makes a yummy chicken dish to eat over rice...really easy and really good!   

Last Saturday we ( Don, mama, Orjantan, Herison and I) went to visit Wema. Turns out, we were breaking all kinds of rules and norms for a student in boarding school!  Who knew??? At first they said we could stay 10 minutes, but later relaxed the rules after we spoke with head master.  We stayed three hours and had so much fun playing cribbage...and UNO!  I brought two UNO decks because I thought it would be easy for Wema's family to catch on. We had a hilarious moment when Herison played a wild card and got to choose the new color. He chose PINK!  They are not used to playing cards so they make many mistakes. They deal the wrong way and even hold their cards backwards so we can see what is in their hand. Fortunately they find their mistakes to be very funny!

Wema is doing extremely well in school. We met a teacher who is sure she will be in the top 5 of her class...if not #1!  And the teacher said Wema is a leader among students and works to spread encouragement and kindness. I am so grateful we are able to support such a deserving young woman!

Don came home from the hospital recently and said, "Well, today I think I was worth what they are paying me."  ($0.00). He has become familiar with the common diseases and the treatments available so he does not hit the books immediately upon coming home. We are also making an effort to get to know the Tanzanian staff which is a delight to me. I don't like feeling like such an outsider. 

Linda and Mark will be back in two weeks which will be really nice!  Ann Rowberg, who is newly retired, will spend most of November with us. We will celebrate her 70th birthday and Thanksgiving while she is here!  So, things are looking up!

Thanks for your interest and your prayers!

❤️Debi