The Wheels on the Bus ....

Well, I got to the bus stop just before 10am and the bus arrived at about 10:45am and we were all hustled on with our suitcases in the aisle and drive the 20 minutes to Kabanga, at the border where we and our luggage were tipped off and the bus dissappeared over the border to Burundi. We just sat there and at 12:30 another bus from Burundi came and picked us up. I got a seat at the back of the bus, with the seats in front stuck in the reclined position so we had no leg room. The ride was certainly an experience. The bus stopped several times an hour to either pick people up or at police check points. It also stopped regularly for toilet breaks, just on the side of the road. Most of the passengers were men and most 6 year olds have better bladder control than them as we had to stop about every hour for nearly all of them to go!

The bus was meant to get to Dodoma at 11pm and I had a taxi waiting for me at the bus port but by 12pm we were still 250km from Dodoma and had to stop in a petrol station for the night and start again at 5am the next morning as buses are not allowed to travel between 12pm and 5am for safety reasons. Well we sat on the bus, fortunately it was cool by then, and the people infront of me talked the whole night so I didn't get any sleep.

W started again at 5am and arrived in Dodoma at 8am. Stephen, the taxi driver picked me up and took me to Heather's house where I collapsed for the rest of the day. Heather is a short term missionary in Dodoma who I had arranged to stay with while I visited Stivin, our compassion sponsor child. Stehpen is the taxi driver she always uses and he was really helpful.

Last Week

It is now half way through my last week at the hospital and I am getting sad about leaving. Rose, Nigel, Lucy and Sarah arrived back yesterday from Arusha, so after 10 days by myself I now have company just a walk through several peoples’ back yards again. We went into town this morning, after I had finished at the hospital, a I bought my bus ticket to Dodoma. 10 hours on a packed bus, arriving at 11pm in Dodoma will be an interesting experience. The bus is not scheduled to leave Ngara until 1pm but I have to be there at 9:30am to confirm my seat. The bus is an international one, coming from Burundi, so if I don’t confirm my seat they may give it to someone at the border wanting a seat. The time it leaves Ngara also depends on how quickly they get through customs at the border, if they are quick then they will leave Ngara early.

Antenatal/ Child Health Clinic

I went on one of the outreach antenatal clinics on Monday which was an interesting experience. After being told to meet at 9am we eventually left the hospital with a driver, 2 midwives, 4 first year nursing students and me just before 10am. We had to stop by Nyamiaga, the government hospital in Ngara to pick up supplies, another midwife and a doctor and somewhere along the way we acquired a fourth midwife. We were traveling in a land rover with 3 people in the front and the rest of us on the 2 bench seats which face sideways into the vehicle. After about half an hour, mainly on dirt track we arrived at the village where we were doing the clinic and set up the child health clinic under one tree and the antenatal clinic under another. I spent the morning graphing the weights of the children on their health cards and then at about 3:30pm we started doing vaccinations. There were at least 400 children under 5 years old at the clinic, which was a lot of cards on which to plot weights.

They use spring balance scales, which they just hang from a convenient tree branch. The scales have a large hook on the bottom, the children are put into a cloth harness which looks a bit like a pair of rompers with long strap and then hung from the hook on the scales by the straps. The whole contraption reminded me of a cross between a baby bouncer and a set of butcher’s scales. Some babies were quite happy in it and some screamed as soon as mum let them go.

Our House

It is going to be weird returning to Australia as after 5 weeks here I am starting to feel at home. Our house, which used to be the Nursing Sisters Quarters, feels like home now. I am quite used to having to boil water for my bath/ shower with a jug and have my bath by candlelight since the light switch broke a couple of weeks ago. I am also getting good at tucking in my mosquito net and then crawling in for the night, checking the corners for mosquitoes before turning off my torch.

I will also miss Judy, our house help, when I leave. She is a good cook and also does our washing, makes our beds and does all the cleaning, as well as leaving a big pot of hot water on the wood stove for my bath. She also makes us fresh juice every day out of passionfruit and a couple of other tropical fruits which I haven’t been able to identify.

The house is just inside the hospital grounds, which has a barbed wire fence around it and only a couple of gates. There is a guard, armed with a bow and poison tipped arrow at the gate closest to our house, and if we come back late at night from visiting the Kleins we sometimes have to wait for him to unlock the gate.  He must remember us now as lately the gate has always been open when we get back. I came back from one of my evening walks down the airstrip with my camera out and the guard saw it and asked me to take a picture of him and of course I agreed (I had wanted a picture but wasn’t sure how to ask him) and he rushed back inside and got his bow and arrow, and then knelt down with the bow drawn and ready to shoot.  It made a great photo and I certainly wouldn’t want to be in his sights if he was serious about shooting

Pharyngitis

Several days after Chirstmas I started feeling unwell and eventually went to Dr Rose, by which time I was aching all over and my Panadol supplies were running low. Rose said she didn’t think that I had malaria, though she would do the test if it would make me feel better, but I definitely had pharyingitis and I should take the antibiotics I had brought with me, take some Panadol, go back to bed and not feel guilty that I wasn’t at the hospital. I borrowed a couple of good novels from her and took her advice for the next 6 days. I can’t remember ever feeling so awful in my life as I did for the first 3 days.  I went back to the hospital after the 6 days but spent the rest of the week talking in a whisper as I had lost my voice. I was certainly glad that I had packed, what I thought to be, excessive amounts of painkillers. They all came in useful.

Christmas

Christmas started with an 8am service, all in Swahili, at the cathedral. We did manage to keep up with some of the Litrugy and found the hymns once they had reached the 4^th verse but other than that we sat there just hoping that we wouldn’t miss the cues to stand and pray. The choirs had been practicing for weeks and were really quite good. Choirs over here usually only have a drum accompaniment and  they dance as well as sing. Church over here is fairly segregated with men and couples sitting on the right side of the church and single women, widows and women whose husbands are not there on the left. The men always go first to receive communion or give the offering.  There is no getting out of giving, regular members have envelopes with their names on them and you get told off in front of everyone if the minister doesn’t think you are giving enough. Even if you don’t have money you take along a chicken or a bunch of maize, which are then auctioned off after church.  Everyone goes up pew by pew to put their offering in the box so it would be really obvious if you didn’t go up. Church went for 2.5hrs, limited by the fact they had to finish so the 10am service could start, and after we had greeted a lot of people we came home to get ready for Christmas lunch at the Kleins. We had a white Christmas, as Rose and Nigel had invited all 10 of the westerners in Murgwanza to lunch. Sarah and Lucy, the Klein’s 2 daughters, were very excited by everything, particularly all the lollies they had received in packages from Australia. (lollies are not very common over here).

Christmas feast and presents are unusual here and it was humbling to contrast our lunch of roast chicken, vegetables and pavlova with the mother and child who came from the Malnutrition unit at the hospital to ask for food, as the food Rose and Nigel provide each month had apparently run out. We found out later that it was locked up and the person with the key had gone away for Christmas. The 2 y.o. child was so hungry he practically inhaled the bananas which Rose gave them.

After lunch Big Sarah, Claire, Naomi and I went to Sarah’s  neighbour’s house, where we had been invited to share their Christmas. We found that they had prepared a big stew, pilau and salad but we could only eat a small amount after our lunch, though we felt bad afterwards as we found out they had prepared it especially for us. 

Shopping

The day before Christmas we ventured into town on our own, just armed with our phrase books to do some shopping. Murgwanza and Ngara (the local town) are at about the same elevation but are each on top of a ridge with a valley inbetween.  The 20 minute walk down the hill isn’t too bad, though reasonably steep but the walk up the other side is a killer.  Fortunately it is entirely normal to give ‘lifti’ to strangers and since there are currently only 10 wasungu (white people) in the area, including us,  people will usually stop to give you a lift. We were fortunate enough to be picked up by a guy from a local orphanage (we had been told that it was safe to accept lifts from 4WDs with writing on the side, as it meant they were from one of the local organisations) just after we had started up the hill. He dropped us at the bank and we walked the rest of the way into town. We had a hilarious time shopping, especially watching Claire’s pantomime to try to buy stamps after she gave up on the phrase book.  We even managed to buy cheese, which is only sometimes available. You have to buy it in rounds so I ended up with a kilo of something like gouda, the first cheese we have had since we arrived. Claire also bought a frozen chicken, (she didn’t take Dr Rufano up on his offer to teach her how to kill one,) as she wanted to have chicken soup.

We started back home, laden with our burdens, and had just got to the bottom of the hill and were not looking forward to the uphill part when the same guy came along and gave us a lift back to Murgwanza.

The Wanafunzi Doctari (Student doctors)

So far we have spent most of our time on the children’s ward and then gone to theater two mornings a week when the operating lists are done. Coming from the super sterilized theatres of Australia it was a slight shock to find that most patients are expected to walk into theatre themselves instead of being brought in on a bed, even a case of a man with a broken hip had to walk in. The people here have an incredibly high pain tolerance and many minor procedures, like setting broken bones, are done with no analgesia and others with minimal pain relief. Major operations are done with either ketamine or ether!!!

On our second day at the hospital we were in theatre when they did a Caesarean section and the baby came out covered with the worst meconium I have ever seen (shows baby was distressed) and was not breathing.  The nurse suctioned the nose and mouth using a footpump operated suction device and then attempted to bag and mask the baby. This didn’t appear to be effective and when she was called to get something for the surgeon I had a chance to step in and help. The baby’s pulse was only 40 beats per minute (should be over 100 and preferably 120 – 160) so I started CPR and the pulse eventually came up and the baby started crying but it was a very long 5 minutes before this happened. It is an amazing feeling to know that the baby would not have lived if I hadn’t been there to help and I am so glad that we received several tutorials early in the year on neonatal resuscitation.

The children’s ward at the hospital has about 46 beds and is divided into a main ward, dysentery (gastro) ward, a malnutrition unit and a 4 bed “ICU”. The ICU is only different from the rest of the ward in that it has an oxygen concentrator (oxygen cylinders aren’t available over here). Most of the children on the ward have malaria +/- anaemia (from the malaria). They stay in hospital for about 3-4 days, receive IV quinine and a blood transfusion and then are discharged. We spend our time after the ward round writing discharge summaries for the doctor. The usual entry in the notes is “Seen, treated and cured”, a lot less information than would usually be recorded back home.  The rest of the cases on the ward are usually pneumonia (or have been diagnosed as having pneumonia because their chest sounds like pneumonia) with a few cases of gastro, which is often due to hookworm.  

On the ward round on our 3^rd day at the hospital we saw a 3 year old boy in the ICU with ‘severe pneumonia’ and ?poisoning who had been admitted about 11pm the night before.  He was breathing about 4 times as fast as he should have been, was frothing at the mouth, had pinpoint pupils and was unconscious. When reading the history taken by the clinical officer we found that he had drunk insecticide the night before!!! Pulling out our trusted Oxford Handbooks of Clinical Medicine (aka the medical student’s bible) we found that the treatment for organophosphate poisoning is atropine but it only gave the adult dose. The doctor then said we would all go away and see if we could find the paediatric dose and then meet back at the ward in half an hour. The 3 of us rushed down to Rose and Nigel’s and when we told Rose what the problem was she came  back up with us. The child had a GCS of 3 (lowest possible score on the coma scale) and only had oxygen sats of 82%!! Atropine is the cure for organophosphate poisoning and in Australia you would give it continuously for up to 3 days. But the hospital only had 4 vials (8 doses) available for us to use, so we gave him these 15 minutes apart and by the 4^th dose he had started to improved and by the 6^th dose he was awake enough to fight us ventilating him with a bag and mask.  Since atropine only works for a short time we expected him to get worse after the last dose had worn off but miraculously he improved and a week later he was completely well and ready to go home. Rose, Naomi and I had all been praying that what we had would be enough but I certainly didn’t have much hope that he would survive the night. God has to get all the credit for this case and the child’s father certainly thought that it was a miraculous cure.

Murgwanza Hospital

The hospital where I will be spending six weeks is very different from an Australian hospital. The head of the hospital is only a 2nd or 3rd year out doctor and all of the other 'doctors' in the hospital are actually assistant medical officers who receive 3-5 years of training and then perform surgery!!! The patients are required to pay for everything, including the gloves, needles and syringes and families must supply the food.

So far we have spent most of our time in the childrens' ward, where they have a total of about 40 beds, including a malnitrition unit. The 'ICU' is only distinguised from the wards by the fact that it is only a 4 bed room and it has an oxygen concentrator (no oxygen cylinders are available over here). Most of the children we have seen have malaria and many of them have needed blood transfusions.

Church

Last Sunday I went with Rose (our supervisor) and a visiting missionary, Dorothy, to a local church. It was an amazing experience and we were treated as honoured guests. After a half hour drive almost to the Burundian border we cam to the church to find a large Sunday School outside singing and dancing. We were taken into the pastor's house and served chai (very sweet, usually milky tea) and then went into the church. We were given seats up on the platform facing the congregation along with the pastor and evangelists from the church (all of whom were wearing black cassocks and then white robes over the top). The church was a well off one as it had a brick buolding with concrete floors and had an electric piano. The service went for 3.5 hrs in total with a lot of singing from the two church choirs, a long sermon entirely in Swahili which Dorothy translated for me, three offerings for different things and communion. After church we were served lunch in the pastor's house and it is amazing to see how different things are over here than they are in Australia. The hosts may not be able to afford the food they serve but becuase you are honoured guests they will give you food and go hungry themselves rather than break the custom of hospitality. This is a humbling experience.

The Journey

 After leaving Perth at 10:30pm on Tuesday I arrived in Dubai early Wedneday morning (local time) and managed to run into Naomi and Claire (the other 2 girls going to Murgwanza) after only an hour wandering around Dubai airport. We passed the time by playing cards in McDonalds before catching our flight to Nairobi.

Nairobi was fun as our luggage was only checked as far as there and so we had to pick it up to put on the next flight. Their luggage collection area is after the visa point so we had to find an airline representative to walk us down to collect our luggage. After about an hour, with awful visions of finding our luggage had been taken, we managed to locate someone to takes us to collect our bags, which were still circling on the carousel. We then had 10 hours to kill before our flight to Kigali, which is not an easy thing to do in a poorly airconditioned airport after being awake for 36 hours.

Our flight into Kigali, Rwanda arrived at around midnight and after buying visas we discovered that Customs is merely a guy standing at a doorway who makes you remove all visible plastic bags (Rwanda is going plastic bag free) and then let us through, no checks, no questions – I had no idea that getting my bag of medical supplies through would be so easy. A person from the guest house we had booked into met us and took us back to the guest house where we fell into grateful sleep.

The taxi took us to the border with Tanzania the next morning and we only had one flat tire on the way and our driver actually had a functional spare!! Rwanda is beautiful and doing quite well. The roads are all well paved (less potholes than most Australian roads) and clean and the buildings are well kept.  Kigali,  the capital, is in a valley and is beautifully green.

We crossed into Tanzania at the Rusumo Falls and after being proposed to by the Border officer in Tanzania we were finally in Tanzania!!!!

The difference once you cross into Tanzania is remarkable. The roads become potholed and are not paved in all places and many of the houses are only woven sticks and mud. The better houses are brick or mud brick with a concrete render and concrete floors.  We crossed a river just after leaving the border on a wooden raft pulled across by three or four men, which was an interesting experience.

Our house, called Masista, is in the hospital grounds and is very nice. It is brick with cement floors and limewashed walls, which leave white streaks on your clothes when you lean on them. We have electricity and running water 24hrs a day. We even have a brand new microwave, fridge and electric kettle. To make sure we still feel like it is Africa we have no hot water and so are getting quite good at bucket baths.

Leaving

Warning to other medical students: Boxes of gloves are surprisingly heavy when you want to pack 10 boxes.

I am off to Tanzania tomorrow night to spend just over 6 weeks at a hospital in rural Tanzania as part of my 6th year medical studies. I will try to keep this up to date to let you know how I am and what is happening.