DCMS members volunteer with FAME Medical in Tanzania: Part 1
Friday, July 19, 2019
Posted by: Drs. Todd Sack & Barbara Sharp
Please enjoy the below update from DCMS members Dr. Todd Sack and Barbara Sharp as they continue their service trip with FAME Medical in Tanzania. They spent two weeks touring Uganda and Rwanda, before heading to Tanzania where they will be working for three weeks:
Dr. Sack's Diary: Days 1-3
7/14 Sun: To Karatu: After breakfast of an omlette, Rwandan espresso, papaya, & Tree Tomato juice, we checked out of Kigali’s Hotel Milles Collines (featured in the film “Hotel Rwanda) and drove 20 minutes to the new airport where we exited the van for the entire vehicle to be inspected by a huge high-tech security scanner.
As last year, taxi driver Charles met us at Kilimanjaro Airport for the drive four hours to Karatu ($80). The crops of maize & sunflowers look pretty good to us but not as robust as in Rwanda. Charles told us that there was “little rain” this year and that people are worried. The herds of goats and cattle are large here, unlike Rwanda where each household is limited to one cow, and here the animals are noticeably scrawny. We passed pyramidal Mt. Meru rising to 15,000 feet and cloud-free, and small coffee farms.
It was dark at 7pm. Charles explained that he slows down at night because in his ten years driving this route he has seen wild game, even lions, crossing the road. Just five minutes later, as we rose up the crest of a hill, we saw a giant bull elephant cross the road silhouetted by the faint blue sky 200 yards ahead!
At 7:45pm, we passed the entrance to Lake Manyara National Park and ascended the 1000’ rise to the top of the great East African Rift.
We reached FAME Medical in Karatu at 8:20pm, met the nice new volunteer coordinator, Phoebe Harger, and moved into our new house that we are sharing with Winnie Musoni, a 29-year old Rwandan refugee who starts nursing school soon in the US.
7/15 Mon: FAME Day 1: Variceal Bleeding: Cool overcast day. Barbara and I were warmly welcomed back at the meeting room for Morning Report at FAME Medical in Karatu. Most of the doctors we know from last year; missing was Dr Msuya who is in South Africa for several years of training and Yale-trained surgeon Kelly Shine; and new is Dr. James, a young Tanzanian from Mwanza.
We discussed the admissions of the weekend. Noticeable were several premature babies 2.5-4 pounds apiece. FAME is known for its neonatal care, especially the great nursing and the working incubators to keep these tiny humans warm.
In clinic, I teamed up with volunteer Winnie who lost her parents in the 1994 Rwandan Genocide. We had fun with her translating Swahili for me and me teaching her medicine. We saw a young woman, a cook, who came from three hours away seeking an upper endoscopy, but I decided instead has Irritable Bowel Syndrome and undiagnosed Essential Hypertension. She broke into tears when we began discussing the stresses in her life. We treated her I.B.S. with diet and hyoscyamine; her blood pressure with amlodipine, and we urged that she return in three weeks to adjust these.
A 58 year old businessman came in with alcohol use, ascites, and hematemesis. I admitted him to be stabilized and arranged transfer tomorrow to a hospital five hours away with advanced endoscopy instruments that we lack.
Every patient in clinic today seemed to come in with one problem but more emerged. A minor stomach upset became also urinary retention from prostate disease and a massive forearm lipoma. A bad cough became low back problems and charcoal stove-induced chronic lung disease (the #1 cause of lung disease in African women).
Volunteers Paul (pulmonologist) and Beth (palliative care nurse practitioner) had us to their veranda for beers at sunset. A bat feasted above us on bugs in the porch light and the full moon faintly bathed the hills of the Ngorongoro National Park two kilometers off.
7/16 Tues: FAME Day 2: Endoscopies: My patient with likely esophageal varices stabilized with propranolol and checked himself out at 5am to drive five hours to the hospital near Moshi. At morning report, Dr Julius told us of several women with profound post-partum anemia and of six pre-mees in the nursery (we are staffed for four).
In clinic, I saw a 51-year old woman w cough, fever, upper abdominal pain and mildly abnormal liver blood tests. After blood tests and a normal ultrasound by Barbara (it’s fun working together), I prescribed doxycycline for likely Leptospirosis.
I saw a 70-year old man with four weeks of vomiting and weight loss. At endoscopy, I found a linear 4 x 1cm partially-obstructing antro-pyloric stomach ulcer & Candida esophagitis. He went home on omeprazole, metoclopramide, and nystatin. Biopsies for cancer cost $80 to process so we’ll send them to the lab in a month if my ulcer treatment fails.
I scoped a young man with a hemoglobin of 4.3, black stools, and newly-diagnosed HIV. I found Kaposi’s sarcoma in the stomach. This upgrades his diagnosis from HIV to AIDS. We hope that the HIV medicines will reconstitute his immune system to be able to stave off the sarcoma. He was discharged next day with hemoglobin of 5.3. While I was doing the endoscopy, Barbara was using ultrasound to guide a surgeon placing a chest tube into a patient behind the curtain in the next bed. Nice Kilimanjaro beers with dinner at our house at 7pm.
7/17 Wed: FAME Day 3: Sexual Exploitation: Overcast, cool day with brief morning rain. At Morning Report, Dr. Julius told us that he admitted overnight “a Maasai warrior who accidentally slipped and the tip of his spear went through the hand.” He is
being treated with antibiotics and will be taken to our operating room today for debridement under anesthesia.
A three year old Masai child, who looks half that age, has heart failure and marked peripheral edema. Barbara did a bedside ultrasound during ward rounds finding a large liver, dilated hepatic vein and no ascites. An echocardiogram will be done today; this may all be due to malnutrition.
We saw a woman with chronic gallstone disease who will have elective cholecystectomy today. Gallstones are unusual here but Dr. Badyana told us on rounds that they are starting to see this more often with the adoption of Western diet habits. This patient fits the mantra for gallstones that every American medical student learns: “fair, fat & fertile”.
In clinic, I saw two pleasant girls, age 14 & 19, who live in a home that shelters 24 girls rescued from sexually exploitation, run by a couple from Sacramento. Each of the girls I saw today had been rented for prostitution by their mothers in return for drugs. Each was here with anal complaints and fears, but fortunately my examinations were normal. I delivered a lot of reassurance together with my usual hemorrhoid and constipation chats.
I discharged my patient with intestinal bleeding due to Kaposi sarcoma, after a long conversation with him and his wife (both recently began HIV treatment, universally available from the government). Our hope is that the medicines can reconstitute his immune system to be able to fight his Kaposi sarcoma, a tumor caused by Herpesvirus Type 6.
Barbara is preparing a lecture on abdominal CT scans for tomorrow and also tomorrow we are giving a dinner party for seven Tanzanian doctors. It will be “kuku”, Swahili for “chicken”!