Happy Australia Day

Yesterday was Australia, and since my roommate is Aussie, I got to celebrate too. We went to a restaurant owned by an Aussie and they had a special menu that night of prawns on the BBQ or beef and mushroom pie and pavlova for dessert. It was pretty good food and fun to meet new people; Aussies and other wannabes.

I've made many new friends here through people who work at the hospital, neighbors, and others I just bump into while playing soccer or hanging out in town. There's a pretty small ex-pat community here. I have an Italian neighbor, Lupo, who is a professional hunter and he had Eric and me over the other night to eat eland and buffalo. I'll try any food once and eland is surprisingly tender and not gamey. People pay lots of money to go hunting here and there are many restrictions. You can't hunt rhino, cheetah, or wild boar and animals like elephants and leopards have to be a certain size and therefore age. So you need to go with a guide and you pay for a 21 day permit, even if you hunt for a shorter time. I think it's about $5,000 for the hunting permit so it's about $200-$300 a day. It's very expensive and the money is supposed to go toward park preservation and such, but every government in Africa has its problems with corruption so I'm not sure how well used the money is here. Park fees have gone up all over the country. It's now $100 a day to be on Kilimanjaro, making the climbs very expensive as well. I figure what's a couple thousand more in student loans when you already owe too much to count.

I'm not sure I could ever drive here. There are no stop lights, stop signs, or any form of conducting traffic and the rule is the bigger vehicle has priority. The one thing they do have is speed bumps. Even though the roads are meant to be 2 lanes, you usually see 3 cars wide because people just honk their horn to pass whenever they feel like it. They're all driving on the wrong side of the road too and I still get confused and go to the wrong side of the car when I'm riding with someone.
The transportation here in Tanzania consists of privately owned sedans and lots of safari type 4-wheel drive vehicles, lots of white taxis, and the dala dalas. Dala dalas are mini vans with seats for about 17 people in them, but they never carry less than about 25. They have specific routes they drive, but there aren't strict designated stopping points so you can hail them down to get on and yell at them to stop when you need off. They cost 300 Tsh a ride (about 25 cents) and they really cram in their moneys worth. There's a driver and a guy who hangs out the window or even the open sliding door who tells the driver when to stop and go by hitting the roof with his hand. Eric and I took the dala dala home from the hospital one day and all I can say is people here have a smaller personal space bubble than I do.

It has dried up here and it's very dusty. I blow dirt clods out of my nose daily and when I use a Q-tip to clean my ears, I get dirt out. When I shower, my tan washes away. Our road is dirt and therefore very dusty. This picture will give you an idea of the dirt that accumulates on the plants along the road.We live in a neighborhood called Ilburo and there are acutally a number of white people around. There are 3 houses that people who spend time volunteering at Selian can rent rooms from. Eric and I are the only people in our 3 bedroom, 2 bathroom house and we pay $150 a month. This includes utilities and our nightly guard. We also pay our housekeeper 7,000 Tsh (less than $7) a week to clean the house, wash dishes, and do laundry. She's really great. We have a nicely groomed yard by our landlord's son who lives next door. We have some citrus fruit trees and what we think are papaya trees that Eric tried to climb to pick the fruit. He didn't make it up the tree, so we ended up shaking the tree until some of the fruit fell. It doesn't seem ripe yet so we're going to wait a few days before we give it a try.

More about the hospital:

Jetlag sets in

I spent the week with a plastic surgeon, Bill Brown, visiting from Denver, CO. He comes to work at Selian twice a year for a week each time. This time his team consisted of an oral-maxillary-facial surgeon, Jim Lessig, a pediatric anesthesiologist, Andrew Veit, and 3 surgical assistants: Vann, Amanda, and Sherrie, all from Denver. Bill's priority is to repair cleft lips and palates and he'll add on other surgery after that if he has time. Even though Bill has been coming here for 10 years, he still sees kids who are 10 years old and have never had their cleft repaired. I guess it's better than when he first came and he saw nearly geriatric patients too.

Monday and most of Tuesday were all cleft lip and palate repairs and after that we saw mostly burn contractures. before and after

I have never seen such terrible contractures from burn scars leaving people with a constantly flexed elbow, wrist, or knee or unable to turn their neck or use their fingers. One 20 year old boy had 90 degree flexion contractures of both his knees and has been carried everywhere by his friends and family since wheelchairs aren't common here. We released contractures on many patients, some with some skin grafting. One patient even had a reverse forearm flap to give him function of an opposable digit. All his other fingers auto-amputated some time after the burn. I got to do some sewing with the contracture releases.There were also keloid excisions and injections, including a huge one from behind this old man's ear about the size of my fist. The most interesting case was the removal of a 4kg sarcoma from a woman's abdomen. It was nearly the size of my head.The OR, or theater as they say here, functions very differently here than in the US. First of all, the turnover is very slow and there isn't a very organized system for supplies so a lot of time is spent running around looking for equipment. Supplies that are disposable in the US are sterilized and reused here. There are drapes and gowns with holes in them and plenty of sharp instruments that aren't so sharp any more. There were a couple occasions where I saw a little ant crawling across the sterile field. I'm sure it had been through the autoclave. The power also goes out here often and so your light may cut out or your suction or your cautery. There is a generator, but it takes a little time to get that going.
The dress code is also different here. The men all wear scrubs and some of the women do too, but many wear dresses made out of scrub material that are just below their knees, leaving their legs exposed. Also, many wear open-toed shoes and at home I can't even wear those in the hospital, let alone the OR.

Here I am doing some sewing

Eric and I got hats from the visitors

The medicine team has also had some interesting cases. The 2 women with suspected cholera I spoke about last time ended up having cholera and were sent to a government treatment center. I checked the incubation time and I'm in the clear. We had another patient in a myxedema coma from profound hypothyroidism and a young woman with brucellosis. Brucellosis is treated with at least double drug therapy and one of those is rifampin. However, rifampin is only available here in a combination pill with other anti-TB drugs and we can't get it separately. So we ended up treating here with a second line agent and she improved and was sent home.