people like us, we don’t need that much

my first week in tanzania was really interesting. obviously, you all read about my severe “homesickness” from kenya, which I should let you know I am almost over. I still miss the kids at little ray of hope like crazy, and I really miss my host sisters, but I don’t feel as upset about it as I was 11 days ago. but I am going back to nairobi for a weekend visit in my couple of weeks… I just spoke to anna and vicky and makena, and I miss them all so much, I will happily spend money on buying another visa to re-enter kenya, and then to re-enter tanzania. I might be crazy, in fact I know I am, but it’s only 250km away.

anyway, tanzania. I have been placed in a clinic called kijenge RC dispensary, RC stands for roman catholic. so there’s usually a few church songs playing in the background during the working hours, which definitely make me feel like I’m in a gospel choir or something (that’s my ultimate dream, to be a gospel singer. I’m just not a good singer nor am I black enough… one day). there’s two huge (and I don’t mean tall) nuns who run the show who I’m waiting for them to start singing “oh happy day”. the clinic is quite nice, they don’t need for much. I’ve had a look in their pharmacy and it’s stocked to the brim – they obviously have great sponsorship.
my first couple of days there were relatively observational, which I expected, and to be honest, it’s really captivating as people just don’t go to the doctor in australia for these sort of things. I sit in with the doctor (who is also my supervisor) as he does consults , and some really interesting cases have come through over the past week. the doctor is awesome, he includes me in the consults and asks my opinion, as well as translating to me what the patients say and what he thinks they have and what he will prescribe, and asks if patients in australia would receive the same treatment. I’m not completely up to date with what diagnoses require what medication, but a few things I recognised and could say yes or no. obviously we don’t have malaria cases back home.

the doctors office; the wall I sit and look at while he chats to the patients

things that came through the clinic last week include (but certainly not limited to):
– 3yo girl with malaria
– 25yo female with hypertension (220/150 on both arms)
– 6yo boy with mumps
– HIV positive woman for medication to prevent spread of disease to kid (niverapine)
– 25yo guy with cut finger
– 6yo boy with UTI
– 30yo female for stitches removal post caesarean
– 8 month old baby boy with otitis media
– 18yo girl with malaria
– 14yo girl with mumps
– baby with facial skin rash whose mother is HIV +
– 8yo boy and his 30yo dad with amoebiasis (a type of gastro) – treated with flagyl (metronidazole)
– 18 month old girl with bronchitis
– 5yo boy with productive chesty cough
– 3yo boy with malaria
– 5yo boy with huge abscess behind right ear (lidocaine before lancing, hardly done at all kid screamed the whole time, lots of shit (obviously not a medical term) came out)

hand washing facilities in the treatment room… yep, gross.

I spent one day working alongside a midwife doing antenatal checkups; learnt how to measure fundal height (basically measuring how big a women’s pregnant stomach is… that’s a very lay person description) and how to listen for a heartbeat with an archaic tool that looks like a weird mini-trumpet but not before harassing the baby through mum’s tum to figure out where the head is, therefore where the chest/heart might be (I’m still practising this new and difficult skill).

some of the things in the treatment room, apparently anything inside the silver tins is sterile. yet to see a steriliser though

some awesome things I learned this week:
– all malaria tests and treatment are free; children just don’t die of malaria here anymore as treatment is free (provided they can make it to a clinic)
– all tuberculosis tests are free
– all HIV testing and treatment are free

I still can’t wrap my head around the fact that we had three mumps cases in the clinic. for those of you who don’t know, mumps is one of the things that we’re all vaccinated against in the big MMR injection (measles, mumps and rubella) at 12 months of age and (I think) the booster is at 2 years. mumps is a viral infection that usually causes painful swelling of the salivary glands, but can cause other serious problems including encephalitis (swelling of the brain), which can lead to permanent brain damage and/or deafness.

I was dumbfounded. like measles, isn’t mumps ‘extinct’? I mean obviously nothing is ever completely extinct – except dinosaurs- as these patients had it. even things like the bubonic plague (the black plague) have surfaced in madagascar and the middle east in the past few months. crazy stuff. I guess because I’ve not seen it in australia, and I know I certainly don’t have an extensive work history due to only just finishing uni, but I’ve never heard or seen anyone being diagnosed with mumps, at least not my age or younger. even though vaccines are pretty much readily available here in east africa (as far as I’ve seen), there are many factors that prevent kids being vaccinated against things that we’ve all been vaccinated against – unless you’re one of those crazy people who believes there’s a correlation between receiving certain vaccines and developing autism. don’t even get me started on that, that’s a topic for another day and a lot of wine… moving on… one website writes about the challenges of getting kids vaccinated here; i) lack of medical personnel to administer the vaccines, ii) lack of vaccines, iii) inability to store refrigerated vaccines in rural areas, iv) inability to transport refrigerated vaccines and v) poor record-keeping (reference: east africa partnership). I’ve seen all of these things, even to the point of only being able to have certain vaccines at the medical camps I worked at in kenya.

beautiful baby girl with the awful skin rash on her face, likely correlated to being HIV+

the baby girl who had the facial skin rash was such a beautiful little kid, I managed to take a picture (obviously after checking it was okay with her mum and the doctor). she wasn’t the patient, but the doctor and I obviously noticed something was wrong. her mum was coming in for more HIV anti-retrovirals (ARV’s) and the doctor mentioned that the baby’s skin rash is almost 100% indicative that she is also HIV+. I’ve done a lot of google-ing about rashes that relate to HIV and haven’t seen many that correlate to the same rash as the baby, but her mum didn’t consent to having her daughter tested on the day. the frustrating part of our job; you can’t force anybody, even when it’s in their or their child’s best interest.

it’s been really eye opening. and I’ve learnt a lot. not in terms of clinical skills, and by no means are they improving, but I’m learning a lot about patient care and how important it is for patients to feel like they’re being listened to. picking up on small cues about how certain medical professionals look at and/or speak to (or don’t) their patients; I know how much they drummed it into us at uni that you need to give patients eye contact so they aren’t feeling ignored. I thought it might have been a culture thing, but now I don’t, because patients are constantly looking at the doctor or midwife, hoping for some sort of interaction, yet they rarely receive it.

on a side note: I’m totally and utterly exhausted. I had no idea how tiring this volunteering thing would be, and I think I’ve been chronically tired since mid-september. dragging myself out of bed some days has been really difficult, I’m really sick of not showering (when the power goes off here in tanzania, so does the power, so you have to get water out of the well in our front yard to bathe with), I’m so so sick of eating carbs and carbs and more carbs (dinner the other night was spaghetti and mashed potato), I’m so tired of having irregular bowel movements and getting ‘travellers diarrhoea’ on a regular basis (yes that’s an overshare but I don’t give a shit) and spending every fortnight sick like I am now.
but it’s made worth it by a lot of little things – including an elderly gentleman who paid for my bus ride home from town yesterday to thank me for what I’m doing for his community. this guy was so unbelievably old (I always say that africans always look young, until they hit a certain age, then they look 150 years old), and had hardly any teeth left, and spoke terrible english, but I felt so humbled by how generous his gesture was. or by the kids and how they have to run their hands over your skin to admire how different the colours are… or pull your arm hairs out.

I’d be lying if I said I wasn’t counting down until my holiday in zanzibar, only 27 days until I’m lying on a beautiful, idyllic, crystal clear beach and actually relaxing. bring it on, baby. I’ll be so ready for a break by then!

when you try your best but you don’t succeed

wai – my new friend from the medical camp in naivasha – wrote of another heartbreaking story yesterday. a patient was brought into the clinic without a pulse. according to wai, an emergency nurse from malaysia, the patient clearly hadn’t been ‘down’ long so went to start CPR, only to be told by the staff (of which there are no doctors) not to worry, that they wouldn’t get her back. probably as they didn’t have anything to resuscitate her with… no adrenaline, not even an ambu-bag.

the girl was not even 16.

yesterday, she died because of her circumstance. because of a lack of resources. because she didn’t live 5 minutes from a level 1 trauma centre, nor have some of the highest trained paramedics in the world at her call. because even if she was brought back, being intubated requires not only a specific skill set but also the resources in the first place, which is unlikely to be seen in a rural sub-Saharan african clinic. having manual airway support and requiring a cocktail of drugs to keep her pressure up requires a clinic to actually have the oxygen and drugs in the first place. and if she then needed ICU care, where would she go? who funds it?

I can only surmise that the staff in this clinic realise all of these potential questions and come to a point where they’re really quite helpless. that the situation is hopeless.

our health system in australia is somewhat in pieces at the moment, it has been for a while. entire wards being shut down, ambulances ramped at hospitals for hours, beds being unused, a severe lack of staff, no support from the hiring body, overworked, underpaid, undervalued. but fuck me, at least we have one. at least it’s not helpless or hopeless. the staff I’ve worked with have always worked tirelessly to ensure a patient gets the most care possible. it may not always be one with a big happy smile on their face, but it gets done. god, we worked on a patient in an ED for over an hour trying to bring him back. he’d been down for sometime but the doctor was tireless in ensuring he’d done absolutely everything for this guy until we called it quits.

and, at least 15 year olds don’t die in australia just because of where they live. even the most rural parts of the country have volunteers/paramedics on call. anyone of us could’ve been born here, that could have been any one of us. I can’t believe I’ve had to attend patients with a broken toe nail or period pain, that I’ve had patients walk into an ED complaining of a hangover, that people call 000 for the man flu or ‘liver pain’ (an actual job I went to) when people are actually sick and dying.
honestly could count more people on my fingers and toes who would benefit from seeing life on this side of the world.

all I have I will give to you

nakuru medical camp.

what a day. I honestly don’t think I’ve been that exhausted since one of my last shifts as a paramedic student after working a solid 14/15 hour shift. and that was in a first world country.

the camp itself was the ‘baby’ of fellow volunteer lindsay who is a nurse from the US and had been in nakuru (a pretty large town/almost a city outside of nairobi by about 3 hours) for a few weeks. the pastor she’d been staying with has set up programs for the people who live at the gioto garbage slum and is well known and respected in nakuru, so he helped set up the camp with her – and by ‘help set up the camp’, I mean he organised everything and used her money to do so. it’s hard being here and wanting to organise things because – obviously – not being able to speak kiswahili makes things a little difficult.

so me and two other volunteers headed to nakuru from nairobi on tuesday afternoon via matatu, which was officially the longest matatu trip I’ve taken; was the point I was at my absolute snottiest and sickest, and I couldn’t even breathe out of my nose. so the poor two kenyan souls I was sitting next too are now probably as sick as I was then. thats how small the vans are. arriving in nakuru at the matatu stop past 7pm when it was dark wasn’t exactly my idea of fun and didn’t exactly encourage the feeling of 100% safety, but we were picked up pretty quickly.

that night we organised the ‘paperwork’ for the next day, which included tearing A3 sized paper into quarters and each patient would receive a piece which would eventually have their name, their vitals, their chief complaint, their diagnosis and what drugs were required. not the extensive documentation process I’m used to, and it’s bloody sweet. none of that “ooh you better document every little thing the patient says/does/breathes just incase of a lawsuit down the track”.

the next morning we were up bright and early for the camp. it was relatively disorganised to start with however once things got rolling, we saw upwards of 700 patients that day. words to describe it; exhausting, tiring, humbling, educative, chaotic, daunting, headache-worthy, but amazing.
we’d been separated into the different stations; registration, vital signs (including BP, temp & weight), adult doctor, paeds doctor, neonatal doctor, HIV testing and pharmacy. there were 8 of us volunteers, 3 of which were nurses so we were to work with the doctors. I was with the adult doctor, although in true african fashion, nothing was organised and none of the doctors had separate specialties so patients sat patiently and waited to see one of the three. initially there weren’t enough chairs for us nurses to sit next to the doctors so I was floating around with the people helping take vital signs, realising pretty soon that we couldn’t take temperatures without a thermometer, so the pastor went off to buy more medication and supplies and comes back with three oral thermometers, because that’s all the place had. excellent, how do we take the temperature of over 700 people efficiently but still hygienically? one of the other nurses had the genius suggestion of ripping off the fingers of gloves. what a legend. I will totally be using that as an example of “tell us about a time you had to improvise…” for my paramedic interview next year.
“well, this one time in africa, I was volunteering in a medical camp and…”

you can sort of see the glove tip at the end of the thermometer

doing the extensive documentation required… on a scrap piece of paper

the vital signs section with kyle, a medical assistant, and wanika, a biology student.

jenny, a psychology student at the pharmacy

checking out what the pharmacy had to offer

so many different ailments and problems came through the camp, people with generalised coughs, sniffles and a whole lot of problems that they had probably had for quite some time but had been waiting/hoping/praying for a free medical camp. the three nurses, me included, were sitting with the doctors and were helping diagnose patients through the symptoms they described. however a few people where seriously sick and had to be taken to the local hospital, pretty quick smart. a beautiful little 6 month old baby had a fever of 39.8 celcius with a distended tummy (I took her temperature, got a bit worried so encouraged them to the front of the line to see the doctor), turns out the poor bub hadn’t pooed for 4 days. the beautiful little girl had a probable umbilical hernia and needed surgery. sadly her mum was the one to convince as she had no money and was worried about the hospital fees. somehow someone convinced her that it could be taken care of later but she really needed to get her baby to the hospital. just one example that shows how different life is here. when I did my shifts at the royal children’s emergency department, mothers (and some fathers) were bringing in their bratty toddlers with just a bloody runny nose… how I wish I could somehow make people at home who really need a wakeup call come step into these people’s shoes just for a day. they don’t know how lucky they’ve got it.

one really ridiculous patient came through stating that his eyes won’t stop watering, especially when he wakes of a morning and when he looks at light. the doctor was sure he had a kind of viral conjunctivitis – very common in the slums (which is where we were). so she prescribed not one, but two types of antibiotics. what?! I’ve already stated how much it frustrates me when people are like “oh I went to the doctor and he didn’t even give me a prescription”… probably because ya don’t need it mate! so this was baffling to me. when she was questioned, she didn’t really give a straight answer. this doctor, she was so lovely, however she was only an intern… still a newbie, so hardly a doctor (shhh), so I think she was a bit scared to start with and just wanted to treat everyone.

we reckon a couple of patients pretty much had tuberculosis, except had nothing to properly test with so it was a symptomatic diagnosis but very strongly recommended for one bloke that he go to the hospital to be tested. he was extremely reluctant because he just thought he had a sore throat but it got to the point where we had to tell him (via an interpreter) that he was putting everyone he came into contact with, including his family, at risk. I think we got through to him, as well as in the process probably contracting TB every time he coughed.

a lady came in with an insanely swollen leg below the knee complaining of pain. straight away I was like ‘holy shit, dvt’ to the doctor next to me, since I couldn’t feel a pedal pulse and her leg was paler than what her other one was. funny considering I thought it would be difficult to tell when people with dark skin have poor circulation. reminded me of a job I did as a paramedic student in mildura when a woman had one huge swollen leg after sitting in the car for 10 hours. we had MICA (intensive care paramedic) backup within 30 seconds and were at hospital within 5 minutes. so this poor lady needed to get her and her swollen, pulseless and pale leg off to the hospital ASAP for some interventions aka anticoagulation therapy.

another volunteer, moriah (a nurse), told me of a lady who came through wearing simply a skirt and a scarf tied around her chest. as she sat in front of the doctor, she removed the scarf only to show the most horrendous wounds and scabs all over her shoulders, arms, chest and stomach. she claimed a candle fell on her, but no one was believing her… moriah said to get that sort of huge extensive burn, she’d have to have had a huge pan of hot water or something tipped or poured on her. It makes me sick and I hate to think what actually happened. I’m pretty sure she got referred to the hospital as well.

sitting playing doctor with the doctors (almost more so than the doctors themselves)

exhausted smile

having a stand up snooze with a very sleep baby who’d been patiently all day with her mama to see the doctor but fell asleep when they finally came through

the group

and I am – again – so grateful to my amazing friends and family who donated so generously before I left. thanks to you guys, all of the donation money I had in my wallet at the time AU $155 (12,000 kenyan shillings) was spent on medications, thermometers and other medical supplies required to help run this camp, because we ran out of lindsay’s donation money. and it was so appreciated by all those people we helped on the day. if I had’ve taken more out beforehand, I would have given more. it was a fantastic day, but so incredibly draining. I haven’t had to think that much since my shifts as a paramedic student when I was treated like an actual ambo and expected to do everything for the patient – assess, diagnose, treat. felt so good to do actual medical stuff, a good 9 months after my last shift in health. but farrrrrk me, when we finally got back home to nairobi at 8:30pm that night, I slept like an absolute baby.

aaaand because it’s never too late to donate !
www.gofundme.com/takinghealthcaretokenya