Habari! (How is the day?) Nzuri! (The day is good!)

Adding to Laura's safari post, I will insert some pics about the trip. We collected several, and I will try to put together a slide show some time as the landscape and animals were truly amazing to be around. I noticed that once you are out of Arusha the country side opens up a good amount with great expanses of land and large mountain ranges. Masai in their colorful plaid blankets roam the land near their bomas (homes) with their cattle. It is peaceful out there and I will try to get out and see what I can. I hope to visit the settlements with a worker from Selian who performs health assessments once Laura returns to the states.

On safari the lions were amazing, although I did not realize what a brutal life they must lead until I looked through our pictures and saw how banged up they get! We saw a small pride attack a water buffalo, and as they attacked several were trampled and rolled on their backs. The last lion standing gave one last effort by grabbing the buffalo's tail, but in the end it got away. It was great watching them come into the valley and slowly surround the 3 buffalo.

As many of you know, Charlie loves chasing birds. My two favorite of the trip- the superb starling and this white/black/orange variety were at our picnic lunch. I tossed them a crumb since I was still not feeling quite well in the stomach and the starlings went nuts on the other bird! Needless to say, you can see Charlie's response!

Today at Selian I worked with the pediatric team again. We have one patient with a kidney disease (nephrotic syndrome) who we just aren't seeming to help. We are hoping to treat schiztosomiasis, a tropical urinary infection, but the drug is out of stock (surprise!). It is a best guess right now anyway. We are treating the syndrome with the usual steroids, and diuretics to help him lose water weight. It is a waiting game right now but frustrating as we don't seem to be helping him.

During lunch, some of the Swedish medical students rotating at Selian mentioned 2 women in outpatient clinic who had attempted suicide by ingesting pills. The first was a young woman who downed some rat poison (warfarin- an anticoagulant, makes you bleed). The other woman had overdosed on unknown pills and was given activated charcoal to help remove the toxins. Outpatient clinic is run by house officers, who are not trained physicians. For all their good intentions they do not have the training for complicated patients. We left lunch for the outpatient ward with an Australian ICU doctor named Matt (pic at his house in a previous post). The story given was that this woman had been seen by a young boy taking unkown pills, and now she was unresponsive. In the small triage room, this woman was out on a bed. She had a coma scale of 3- as low as you can get. It was frustrating because people like this should not get charcoal as they can aspirate it into their lungs. It was also frustrating because she needed a respirator, cardiac monitoring and appropriate labs. The best she would get were IV fluids and an oropharyngeal tube so she wouldn't choke on her tongue. In spite of this it was good to see where I might be more useful in the future as a trained emergency medicine physician and help Selian improve their ability to care for patients like these.

On the way out of the ward Libby noticed the girl who had taken the rat poison. She was sitting in the waiting area waiting for discharge. It was a good catch by her because the girl needed to be admitted for observation and given a shot of vitamin K to counteract the warfarin!

Tonight we decided to consolidate all the Selian volunteers into the exempla house down the road. The recent break-ins around Il Buro have ruffled some feathers. We quickly packed up our house as the electricity had been shut off and it was getting dark. The place is really nice, although it was hard for us to leave MButuai (our guard). We are going to try and stop by to see him after the move. While we waited to go he brought out a book on Masai and we talked through the pages. We discussed his traditions a bit and he brought out his Rungu (a 1.5 ft heavy wood club with a small ball of metal on the end), which he can use as a weapon. It was pretty awesome.

We ended the night unpacked and tired. I got bit by a large ant while unloading and will try to get a pic of one sometime as they are impressive. It is amazing what you can see on the ground at night with a headlamp. Endless activity amongst the ant hills as hundreds of ants attacked nightcrawlers coming out in the night!

Eric

ps- Charlie is becoming proficient at: habari! and this goes far while walking around Arusha.