Hospice Week

A picture heavy entry here!

There is a lot that has happened over the last week both at Exempla house and the hospital. This week we spent time getting to know our yard. We made mixed fruit juices from passion fruit, guave and mangos. We also cut down our first bunch of green bananas. While looking for avacadoes we also came upon a great little lizard! On Saturday we had a scourge of biting ants march across our yard. I could not get a sufficient picture, but they were a menace. Eventually our gate keeper cleared the ants with kerosene.





































I started walking home from Selian this week as well. The ride is usually quite bumpy, but it is a very nice walk home taking about 1-1.5 hrs. It allows for a lot of time to think. The kids here seem to learn limited English- mainly "give me _____ (money/pencil/your water!)". It's quite rude I have noticed, but enough tourists have visited to make a decent payoff for them to continue. Other locals are much more pleasant to visit with. I was able to chat with some while they tried fixing the brakes on their bicycle today, and was invited to lunch at a local farm. You will often see women carrying something on their heads: water buckets, bags, firewood. And several herders with cows or goats. But the landscape alone would be worth the walk. The weather is pleasant and there is a view of Mt Meru as you go. Right now there is a deep layer of dust in some areas, reaching several inches.



Pole pole, so the saying goes here: slowly, slowly. Last Monday morning was all about slow. I sat through 3 hours on work duty hours in Swahili. I then took 40 minutes for tea as I waited for medicine to start rounding the wards. I stepped into the hospice office but received looks like I was interrupting more than tea time so I went back for more tea. By 1PM we had finally rounded on half the medicine ward.

The cachectic woman I previously mentioned had an ultrasound performed and a diagnosis of either cholangiocarcinoma (gall bladder) or pancreatic cancer. Either way she has been referred to surgery for possible paliative care, and to hospice services. From the perspective of public health it is an interesting case because there does not seem to be adequate pre-hospital care for these communities to catch advanced diseases. People are so secluded by geography that they rarely seek help until problems are too advanced for inconsequential actions.

I enjoy the hospice team home visits because I can get out into the community and am able to use my training well while outside the hospital, which I find fulfilling. There is a new patient that I met last week on a home visit who is now at Selian. Walking up to his home, we were met by several elder Masai women. Getting inside the small doorway it was very dark and difficult to see well. We were squeezed in, sitting around the bed of a 40 yo man. He was lying in bed, telling his story. After he sat up, it became obvious that he was going to need more than hospice could offer. His legs were covered in small Kaposi's sarcoma lesions, they were more swollen than anything I have ever seen, he was fatigued, had a cough and what sounded like a pleural friction rub in the lungs. This all added up to a likely (as yet) undiagnosed case of HIV/AIDS with associated Kaposi's sarcoma. Until he was in the hospital I thought he might have TB, common things being common, but the sarcoma had spread into his lymph nodes causing the leg swelling AND into his lungs. He is now being prepared for chemotherapy which should help decrease the sarcoma and start on ART for HIV. In the picture I am checking inguinal lymph nodes to show the hospice team the exam maneuvers and to determine the extent of the swelling.






While rounding today I diagnosed my first heart block and was able to talk the interns through what it was, what it sounded like and what would be best for the patient. Unfortunately she likely needs a pace maker, and this is not something commonly accomplished in Tanzania...













Today I came home to a very tired Laura who had taken Charlie all over Arusha. He was a ball of energy and all over the yard/house/floor today. He apparently seized the day and throttled it!!!











Laura is enjoying herself and seems very happy these days. She is relishing her last 2 weeks here. Tomorrow she is going to Step by Step while I spend time with Charlie. She is going to help coordinate peds activities, but I will let her tell you all about it tomorrow!

I will add more to this tomorrow, because it is late here!
Eric