Being a patient at Nyakato Health Center

*** The italicized text is told from the perspective of a patient and the normal text is told from the perspective of the student assistant****

Upon arrival at the clinic you wait at the Mapokezi (reception) window to receive your number. Assuming the power is working, Mariam processes and prints your chart. If you are a new patient a crisp white piece of card stock with your name, age, and address still warm from the printer is handed to Elizabeth, fondly known as Bibi (Grandma), who brings the chart to the triage tiki hut. If are you are a returning patient you must wait until Mariam has time to pull your chart from the shelves. Filed in manila folders with tattered edges, worn from being shoved in and out of the shelves so many times, the old patient records are kept in batches of 100. Mariam sifts through each numerical file until she finds the correct number. Your chart is pulled and sent off to triage.

In the triage tiki hut you await your turn for your most up to date weight, temperature, blood pressure, and pulse to be recorded. My favorite patients are the babies who are weighed in a gray sack with leg holes on one side and ribbon on the other. Once the baby is inside the sack you hang them by the ribbon onto the hand held scale where they remain suspended in mid-air, dangling precariously, until their kilograms are recorded.

From the triage hut you are taken to wait in front of the doctors office. If you are the student in charge of triage, every time you bring a patient to the doctors door, you must knock, wait for the infamous karibu (welcome) from inside, and then hand the doctor the chart. It doesn't matter who is in the room or what kind of procedure is occurring...patient privacy is a concept that has yet to ripen at Nyakato. The patient then sits on plastic picnic chairs outside the office, anxiously listening for their name to be called.

If you happen to be assisting the doctor for the day you better have done your hand warm-up to prevent serious writer's cramp. Not only do you take the history and write the physical exam by hand in the patients individual chart, but then the information is recorded in the government log book. On top of that if you are going to send the patient to lab you must re-write all of their data onto the lab form and then again on the prescription pad. It gets tiring!!!

After waiting outside for up to an hour you are finally called into the doctor's office. As you begin to reveal your aches and pains at least two other patients enter the room bringing their lab results back or a nurse pops in with a question, or by far my favorite interruption occurs when the local ice cream van arrives and sooner or later a dripping ice cream cone is handed into the doctors office. Slurping down the quickly melting ice cream Dr. Bon cuts to the chase. Do you have a fever, body aches, mouth sores, night sweats, a cough, nose bleeds, heart palpitations, vomiting, diarrhea, or abdominal pain? If you answer yes to any of the above symptoms, you can be assured that you will be sent immediately to the lab for a malaria blood smear. With lab sheet in hand you scurry back to the reception window. This time you fight for a spot in line to reach Mariam and pay her for your lab test. With the official stamp firmly etched on the bottom of your lab sheet you are off to the Maabara (lab). Fingers are pricked, blood is drawn, and lucky you if you need a stool or urine sample. The patient bathrooms are located outside the clinic about 100 feet down a well worn dirt path. After receiving your numbered specimen container from the lab you traipse to the choo (toilet) and then back to the lab again with filled specimen container in hand.

When you are the student helping in the lab your favorite jobs are the finger pricks and blood draws. It is unfortunate if it is your day to help in the back. Essentially you are on urine and stool duty. Every urinalysis is dipped, read, and a microscope slide is prepped. Now the urine is not that bad. Stool on the other hand, leaves room to be desired. More often than not you hold your breath as you open the stool sample container. Using a broken wooden dowel you scoop a small specimen onto the slide, smear it around in iodine, and then close the container and dump it into the trash can as quickly as possible. Jimmy,the lab technician, reads all the slides and writes the results on the patient's lab form. Everything is recorded by hand into Jimmy's lab book before you return to the door of the lab and call out the patient's name, often making a fool of yourself for your mispronunciation.

Results in hand you rush back to the doctors office where you simply stick your hand around the doctor's door waving your lab sheet until the doctor pulls it from your grasp. Sheet in hand the doctor shuffles the lab results back into the growing stack of charts on his desk. One new patient, one set of lab results. The never ending cycle continues.

When you are called back into the office to get your results you may not even sit down before you are handed your prescription and sent on your way.

Third time's the charm at the reception window. You pay for your prescription and then waltz across the entrance to the pharmacy window where Fridah counts out pills by the dozen.

A quick trip to the doctor takes at least two hours on a good day. However, you never hear anyone grumble or grimace. Instead the open courtyard waiting room is filled with friendly banter and children giggling. This is why I love the Nyakato Health Center, despite its inefficiencies.

Amit just posted a blog about our health education presentations so check it out!!

http://theguptaman.blogspot.com/

Mtotos (Babies) in Tanzania

Location: The Maternity Ward of Sekou-toure Government Hospital, Mwanza, Tanzania

As we neared the ward I could already tell that it was the maternity suite by the sea of women with watermelon bellies pacing the outdoor corridor. The bleak exterior masks the hustle and bustle that occurs inside. The building is divided into three areas. To your left is the pre-delivery room. Beds line the wall but most of the space is taken by women squatting on the floor or walking back and forth in an attempt to quell their labor pains. Every so often a nurse walks through the ward and immediately the women lie on the beds as the nurse checks to see how dilated they are. Only when a woman is fully dilated at 10cm is she permitted to waddle to the delivery room. Until that time she walks, squats, and grimaces trying to bear her labor pains in silence. In the delivery room women lie virtually side by side on metal tables. As they enter, they carry kangas, large brightly colored swaths of fabric, with them. One kanga is laid down on the metal table as a mat, the second set aside as a towel for clean up, and the third is used as the only identifying mark for the babies when they are born.

No pain medication, no water, no moral support, only the nurses voice repeating breathe, breathe. Within minutes of lying on the delivery table the baby is out and placed immediately on the mothers stomach. No APGAR score is taken, no suction is performed. Instead the nurse waits for the baby to cry to assure that it is breathing.

The baby is removed from the warmth of their mom's bare belly and the umbilical cord is cut. Carried by one arm, the new baby is weighed on the cold metal scale using the discarded packaging from sterilized gloves as the sanitary protection. The weight and approximate time of birth are noted and the baby is swaddled in the vibrant kanga, their mother brought, and left to fend for itself on the tiled counter-top.

The nurses attention turns back to the mother. She clamps the remains of the umbilical cord and extracts the placenta. Using experienced hands she massages the woman's abdomen to help reduce the flow of blood. The dirty kanga and other waste is placed into a bucket on the floor. The new mother then sits on the same bucket and is instructed to continue massaging her own swollen abdomen to push out any remaining fluid.

It is now 12:05 pm. The baby was delivered at 11:58. Mom is hustled to get up off the bucket, wrap herself in her kanga, pick up her baby and walk out of the delivery suite to post-partum recovery. Efficiency at its maximum.

Still wearing the same pair of once sterile gloves the nurse pours water on the floor and metal table. A mop sized window squeegee, squeaks across the floor, leaving muddy streaks in its path. The table is not even dry before the next woman has launched on top, ready to deliver.

After watching a day full of births I can't help but remain amazed at the strength of the women. With no pain killers or moral support they are off the delivery table minutes after their new baby arrives into the world. The nurses eyes are kind but her words and gestures are matter of fact. She delivers at least 40 babies a day so one woman's pain blends into the next. With no crash cart or resuscitation equipment, I wonder what happens in emergencies. Maternal and infant mortality are still extremely high in this area and after seeing the labor and delivery conditions in the “best” hospital, it is hard to not feel somewhat disheartened at the conditions. The uplifting part is that I can truly see how wonderful the new birthing center that International Health Partners has built will be for the women of this community. It will be revolutionary.

Safari!!!

One week has already passed since we left on our safari, but all the details are still fresh.

Friday, 8:30 AM anxiously awaiting the arrival of our already half an hour late vehicle we begin to wonder if we have crossed the threshold of African Standard Time. Urged to call our agent, Amit reluctantly agrees to drop 300 of his remaining 600 shillings in order to find out the ETA of our driver, Vincent, and cook, Bosco. Minutes later the souped up excursion sized, Landcruiser arrives: massive tires, three rows of paired captain seats, a built in fully powered mini-fridge, electrical outlets that don’t work, and best of all, the type of sunroof that would make a convertible jealous. Stocked with M&Ms, our saving grace, we’re off!

Crossing the gates into the western Serengeti, the landscape quickly changes from rows of Coca-Cola and Sprite faced buildings to endless straw shaded fields. We are all excited by our first sightings of zebras, wildebeests, and gazelles, but soon grow anxious to see the rarer animals. Priyanka’s wish list: 1. baby elephant, 2. male lion, 3. lots of giraffes. The landscapes are incredible. Herds of wildebeests are everywhere as the timing of our safari happens to coincide with their annual migration through the western Serengeti. Interestingly, just like humans trying to escape the heat, they often cluster in groups in the shade of some of the bigger trees that happen to spring from the occasional spot in the otherwise flat plains. Midday, they group directly under the trees, but as the sun looks sideways in the late afternoon, the groups slowly seep out from under the branches in pursuit of the slowly elongating shadows.

Only three hours past the western gate we happen across a water source, and with it a gathering of animals. In dry season, the dwindling number of rivers and streams funnel the herds in. Perfect bait for hungry lions. Just seeing the lions is a gift, but Vincent believes they may be preparing for an attack, so the engine is turned off and we become part of the scene. Female and cub arise from their slumber, ears point, shoulders tense, head lowers. Such a contrast, from our six bobble-heads, looking every which way trying to grasp what she senses. We click away knowing something is amiss, and then she shoots out from under the tree, through the brush and around towards the back of the car. Within seconds her jaws are clenched around the neck of a wildebeest and she is joined by the regal male, all of us had failed to even notice. The site is astounding. Just ten yards away from our vehicle. Male, female, and cub, with dead wildebeest are all that are left of the scattered herds.

We were more than spoiled on our first day, but nonetheless continued to be awed by the beauty of the landscapes. The grandeur of fifty plus elephants controlling their stomping ground and families of giraffes careening their necks to enjoy their balcony view over all the action were only a couple of the memorable sites. And interspersed throughout the weekend, lion spottings never failed to spike the adrenaline. On our last night we even enjoyed a special visit from the neighborhood elephant. Tired from a long day we had gathered at our campsite expecting only a mix of tents, tired safari goers, and a peaceful evening. Instead we found a crowd gathering near the fenced in cooked stations. Word was that one of the older wiser elephants had figured out how humans keep their water year round. Having departed from the toil of finding water in ever changing streams, he had made it a habit to just take a stroll in our campsite over Ngorongoro for a daily sip from the communal reservoir, haha!

By Priyanka and Amit