After the Match

A lot has happened over the past week or so, making it difficult to attend to a blog. I have been walking home from Selian a lot this past week, and have noticed I am on my last belt notch now- going to have to start eating more for dinner!


Selian: I have bounced around hospice care and medicine wards again last week. Beginning in March the hospital changed from private Lutheran to a government hospital (with no shift in the Lutheran function). The basic change is that children, pregnant women and the elderly are provided FREE care, with small bills for items such as linens, etc. There has been the anticipated increase in patient load, and this is likely to continue for some time. One disadvantage to the timing of this is that when ALMC (the new Lutheran hospital) opened, they took several of the most qualified team members with them- nursing, clerical, attending doctors. Selian has scrambled to rebuild, but it will take time. The hospice patient I described last week with HIV/Kaposis ended up having pulmonary TB as well. He died last Saturday afternoon, likely from the kaposis and TB disturbing his lung function. It was a very sad time in chapel when I heard about it during morning report. He presented so late in the disease course that there was not much we could do, and he was too sick to transfer to KCMC for the chemotherapy he needed. This past Tuesday I helped orient 2 new students from New Zealand. The pic posted here of Selian is from just outside the chapel- looking in the background you can see Mt Meru!

The Match: There has been a lot of excitement this past week leading up to Thursday evening (we found out at 8 PM). With Laura and Charlie leaving for home on Monday I took Wednesday afternoon through Monday off. Thursday morning we walked into town for some food and also bought a nice bottle of Jameson and Johnnie Walker whiskey to celebrate. They were nice to help calm the nerves during the final hours. We had several people over for dinner- Mat & Jane, David & Julian (new zealand med students), Mark & Linda. Bryant, Laura and I made some chicken masala and lentil indian dishes for dinner. After we found out we were very happy to find out we were going to stay in Minnesota at Regions Hospital in St Paul. Since then I have received several emails from the program welcoming me- very nice to feel wanted!

Public Health: I have lately been working on a project for my public health degree related to malaria. I am hoping that I can use it to complete my MPH degree. Right now I am basically looking through last years lab book and taking noted on all the patients who had malaria slides taken. Were they + or - for malaria, how many slides completed, etc. Then I start looking through their files to see if they were given anti-malarial medications, ever had a real temperature, etc. The reason for all this investigation is because I noticed that malaria was diagnosed here in almost every person, even if there was not a scientific reason for it. The hope would be to eventually create a study that would help them test malaria better or treat more appropriately.

Life: Last night we went to an outdoor bbq and movie night. Sarah hung a sheet in her back yard and we watched "The Gods Must Be Crazy", that is until the power went out at 9... Laura and Charlie left for home last night. We had a very fun morning together, and spent the last few days spending a lot of time together. I am noticing their absence though- not being woke up at 6:45 every morning to "Hi!" from Charlie in the crib right next to us for one thing.

2nd part! Best part!

We found out tonight that Eric matched at Regions in St. Paul. We are very happy and busy thinking about our next "move" as we have everything in storage right now! Thanks for all the support. We will see you all shortly!

The first part of the news!

Eric matched!! Yeah! This is a relief for Eric. I knew he would match...too smart and too good. Anyway, Eric just went to Selian and Charlie and I are kicking the soccer ball in the yard. "Boots" "kick!" "ball!" (that is what Charlie says.)

36 hours until Scramble Day

Monday at noon I will know IF I matched. No real news here, but an excuse to post a video of Charlie again:





Charlie tried waking up Laura with some passion fruit this morning! Didn't work!!







And some pics from the yard, flowers are blooming daily!






















































Hope all is well with everyone, things are going well here. A more detailed update tomorrow evening!!!
Eric

ps- the pics don't do justice to the beauty of this yard...

3 days until match day

So I am a bit anxious to know THAT I matched (March 16, noon) and then WHERE I matched (March 19, noon). I don't usually dwell/wish for tomorrow but this week I actually do. Charlie is babbling away and trying to sing now! Very entertaining, enjoy:





Eric

The way of life in Arusha

The following is a typical day in Tanzania, read on: Last week, I made arrangements with Margaret, the gal that runs Step by Step for the handicapped kids, to come today for the whole morning without Charlie to work with the kids. I arranged the time with Eric so that he could look after Charlie and I was excited. This morning, I sent out my notes on the kids via email to Margaret and then had a taxi pick me up and take me there at 8:30am. I paid him 6000 schillings (about 5 dollars) and he dropped me off at Step by Step. It was closed, locked up, shades drawn. I waited for 30 minutes and finally texted Margaret, "did I get the start time wrong?" No, she replies, "I'm sorry. I forgot to tell you. It is a public holiday" end text. I then text my taxi driver to see if he can pick me up (he gave me the best deal) but to no avail...he is not answering. I walk about 6 blocks until I finally find a taxi. Since it is a public holiday (which I was not informed of), there are very few people working at all today. I find a taxi and they want to charge me 8000 schillings. I say, "no, 7000, and that is my final offer. Otherwise, I will take the dolla dolla," which is a joke because if my goal was to end my life I would take the dolla dolla. He finally agrees on 7000 schillings and I get a ride back to the house.

A little bit about the taxi ride: no seat belts, no shocks, car feels like it is falling apart. As we pass the patrol, the taxi driver half heartedly wraps his seatbelt around him (the only seat belt in the car) without buckling it until we pass and then swings it back to his side. The ride up to Il Boru is very bumpy and a car without shocks feels truly like it is going to fall apart. A few times up the hill I thought to myself, "I'll just walk from here. Pole, pole car..." I get to the gate and am finally home. "Karibu sana" the taxi driver says (you are very welcome) and I come inside. I am frustrated, have just spent about 11 dollars for nothing and did not help anyone today (except maybe the taxi driver). Then, I remind myself, it is just the way of life here...

Now, I am going to play with Charlie and Eric!

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