Mt. Meru Regional Hospital

One more week in Tanzania!

I spent this past week working mainly in the "Prime Unit" which is basically the NICU. I wanted to share a bit more about the hospital to showcase some of the differences and how little the doctors have to work with.

Mt. Meru Regional hospital is a government-run state hospital so all funding is allocated by the government. It is a tertiary hospital so it gets referrals from other smaller clinics and hospitals and offers surgical, OB-Gyn, and ophthalmology services in addition to pediatrics, medicine, and emergency services.

The pediatric wards (P-block) consists of an ICU area, P-1 which is for the kids who are sick and need observation but not really critical, P-2 which is for the kids who are almost well enough to go home, and the Malnutrition Ward. Then there is the Prime Unit with the critical babies, premature babies, babies under observation, and even a Kangaroo Mother Care unit (google it)!

Each ward is just one big room with a few beds, if there aren't enough beds then there are 2 kids to a bed. This is so scary to me because sometimes you have 2 really sicks kids sharing a bed, or you have one kid with TB meningitis in the bed next to a baby with pneumonia. There is also no such thing as heart monitors so if a child or baby in the NICU stops breathing... you don't know until someone goes to check...absolutely terrifying.

I spoke before a bit about how some of the pathologies I've seen here are ones not commonly seen in the US. All children are screened for HIV and malaria upon admission. There is an entire TB ward and all meningitis kids (which are a lot more than in the US) are also tested for TB. Diarrhea is usually a result of dysentery and typhoid. Most of the neonates admitted in the Prime Unit have "septic cords" after being delivered at home in non-sterile conditions. Even conditions that are typically seen as being pretty routine to treat in the US, like DKA, sickle cell, and pneumonia, become a lot more complicated and life-threatening when resources are so scarce.

Each morning all the mothers take the kids out into the courtyard so the nurses can clean the wards (except for the ICU) and then they come back in in time for rounds. If labwork is needed that our lab isn't able to do (which includes CBC differentials and basic metabolic panels...something done for almost every patient in the US) then the parents take the blood samples to other labs and bring back the results. The mothers also take the kids to radiology themselves if x-ray or ultrasound is needed (only imaging available here) and bring back the results. If they can't afford the cost, it doesn't get done.

The options for medicines are also pretty limited and the hospital's stock is extremely low so the doctors write prescriptions and the parents have to go to the pharmacy, buy the medicine, and bring it back to the hospital for the nurses to administer.

Because it is a government hospital it is where people come when they can't afford to go to a private hospital. Therefore, many patients are from poor rural areas, or are Maasai, which is the largest tribe in the area. This means that we see a lot of malnourished kids and kids who are really really sick after parents went several days or weeks without seeking treatment. Maasai are historically nomads and herders so there diet consists mostly of ugali (porridge made from cornmeal) which is also then sometimes mixed with cow blood (an intern asked if I wanted to try). So, basically, a diet without much protein and nutrients. Kids are then brought in bloated, severely underweight, anemic, and with Rickett's Disease (osteoporosis for kids...not good). More so if a new baby was just born in the family, then the next youngest may become more neglected. Yesterday I even saw a 2 day old with bloody gashes on his stomach that were Maasai tribal markings.

I don't mean to give the impression that anyone here is is unkind or neglectful. All the parents care about their children, all of these things are simply a part of their culture and they were never educated regarding the health risks that can result from some of these practices.

I must say the doctors here are quite astounding. The interns work incredibly hard and everyone makes the best of what is available to help provide the best care. It's certainly not easy.

Tanzania - Week 1

Oh boy, where to begin?

I can't believe I have already been here one week! I have so much to tell!

If I had to say one thing about Tanzania it is that the people here are so incredibly nice and welcoming! As I mentioned on Facebook, the word I hear most often is "Karibu" which means "You are welcome". It is said in response to "Thank you", when coming home, when sitting down to eat, and to any and all guests and visitors.

The best example of the kindness of Tanzanians I have is when I first arrived. My flight got in at 2 am and there was supposed to be a driver waiting to take me to the house where I am staying. Up until this point I had had absolutely no problems traveling, which, if you know me, is kind of unheard of. All my flights were on time, I had no problems with customs or security (I usually get picked for special searches), and all my luggage made it! But when I walked out of the airport into the warm night air, I couldn't find my driver. There were many drivers there waiting to pick up people who were traveling for safaris and Mt. Kilimanjaro, but no one for me. I decided to wait for a bit before panicking and calling the contact numbers I had. As I waited other drivers kept coming up and asking if I was okay and what company I was waiting for. In other places, this could have been simply an attempt of others to drive me and overcharge, but here the drivers were genuinely concerned for me and wanted to help. When I got out my phone to try to start calling numbers one of the drivers took out his cellphone and started calling for me. He eventually got in touch with the director of the Child Growth and Development Center, Father Faustine, and it was arranged that I would be driven into town to meet him. It turns out there was confusion with my arrival date and they thought I was coming the next night. Despite the fact that I was by myself, at a foreign country's airport, at 3 am, I never once felt scared...I think I would have been more nervous in the same situation in the US.

I ended up having to spend the night at Father Faustine's parrish since the house was not yet ready. The next morning I had breakfast with Father Faustine and he showed me around his church. He told me a little about local culture and the mission of the CGD. He explained that women are still very much considered second-class despite the fact that they do the majority of work. Polygamy is also still common in rural areas and men like to have lots of children because then they have more animals and more prestige. But then women struggle to care for and support so many children. So the main mission of the CGD is to empower both women and children; to teach them how to raise themselves up rather than simply providing charity and then leaving. #girlpower

I eventually got to Tulivu House where I'm staying for the next few weeks. It's in a rural area between two villages (one of them is called Chekereni, because a railroad runs through it...get it? Chek-e-reni...check for train? Hahaha it kills me!), and about 20 minutes outside of the city of Arusha. The house is very nice and meant to sleep up to 6 people but since it's just me this month, the housekeeper/cook is also staying here so I'm not alone. There is normally running water and a shower but there has been an 8 month drought and so I'm currently taking cold water bucket-baths.

Actually, my first day here we got some rain, and then it has rained at least a little every day since (it's currently summer here) and so Father Faustine said that I'm a blessing since I brought them rain. You know where this is going right??

I blessed the rains in Africa. (mic drop)

Sorry, but you had to have known that was going to come up sooner or later!

Judita is the housekeeper, and guys, I swear she's like a ninja! I don't even notice that my shoes are gone until they're back in my room all clean. And she keeps me very well fed...so much food! She also always has hot water for coffee out on the table morning, noon, and night and gives me fresh mango and avocado with every meal because she knows I love them. I think we pretend to understand each other more than we actually do, but she is teaching me some Swahili and we go on walks to the villages some times.

I spend my days in the pediatric wards at Mt. Meru Regional hospital in Arusha. It's a government hospital at the state level (there national level hospitals as well). I'll talk a little more about my time at the hospital in a different post, and if you read my last post then you already know a bit.

I haven't ventured out much besides going to the hospital and around the house mainly due to a cold that kept me home-bound this weekend. It's also a little nerve-wracking to go out and explore on my own in the city. I stand out as a foreigner even though there are tourists here and so I get a lot of stares and people greeting me. Again, it's part of the culture of everyone being so welcoming, and I love having kids always waving and running up to say hello, but as someone who gets nervous even talking to people I know, it's a little unnerving having men come up and want to talk to me or invite me in for a soda. On Friday at the hospital someone walked up, asked how I was doing and then said "let's go!" When I asked where, he said "The canteen!"

But overall I love it here! Everyone is kind and so happy and grateful for whatever little they have. It's incredibly humbling.

My neighbors!

That's certainly plenty for now. I'll be back to talk more about the hospital and hopefully have more pictures!

The Laundry Basket

Let me say straight off, this is not a happy post or an easy read.

I will write a happier post tomorrow recounting and describing everything I've seen and experienced so far (with some pictures) so please feel free to just come back another day for less serious things.

But for now, I just need to write about this.

Over the past year, I've seen some pretty sick kids. I spent a month in the ICU at the Children's Hospital of Pittsburgh. I spent time on the Neuro-ICU service at CHOP. And I spent last month on the Pediatric Rehab team at DuPont Children's Hospital. I've worked with children that I knew were going to die, that were abused, and that were permanently impaired simply due to bad luck. But as odd, as it may sound to some... these are the patients I love to work with. That doesn't mean I don't feel it or that it is by any means easy. I can't begin to describe how it feels. But I want to take on the really sick kids because they need the most help; they have the most to lose. And they are proof that no matter how bad it can get, they are still just kids first and foremost.

But the kids I've seen already in one week here are a different kind of sick. We do see the typical pneumonia and GI bug kids (although more likely to be typhoid than just a virus) but we also see TB meningitis, severe malnutrition, heart failure due to rheumatic heart disease, and severe anemia. These are kids who are sick due to severe poverty and lack of resources. And while the doctors and nurses that I have worked with are wonderful, there simply just isn't enough.

On Monday we admitted a 5 month old with an ear infection. But she was also so malnourished that she was smaller than most newborns I've seen. It turned out that she was a triplet and all three were malnourished since the family couldn't afford to adequately feed all three. We admitted and treated her and she moved upstairs to the malnutrition ward. All three babies were with the mom in the hospital and on Wednesday the mom came down saying one of the other triplets had been eating and then vomited and had trouble breathing. We admitted this baby to the ICU (just a room with less beds and and closer to the medicine and oxygen concentrator) and hooked her up to oxygen but she had a low heart rate and extreme difficulty breathing. She was also severely dehydrated from having several days of diarrhea which we were not previously aware of. She was a sweet little thing, responsive only enough to wrap her tiny hand around my finger.

We went on with the rest of morning rounds and admitting new patients. Shortly before leaving, a worried mother came in with her 9 month old. She had had a fever and decreased appetite for a little more than a week and was brought in after having a seizure. She was given a dose of Valium to prevent more seizures and so when we examined her she was asleep but still arousable and responsive. She fit all the criteria for meningitis. After crouching down to examine her as she slept in her mother's lap, she kept stretching out her legs and resting them on my arm. So I sat there and held her little feet in my hand as we finished the admission. I took her and her mom to an ICU bed where we planned to do a lumbar puncture to confirm the diagnosis of meningitis. I went with my intern to try to go track down some blood for another severely anemic patient (the intern ended up donating her own blood since there was none). When I got back, the girl was still calmly sleeping in her bed with her mom and it was time for me to go home.

When I came in the next morning, I didn't see her anywhere and I asked where she went. I was told she passed away the previous evening. All I could think about was her feet in my hand.

But work for the day had to continue. I went to see the triplets. The little girl who was really sick was struggling to breathe and not reacting at all. She did not move or make a sound as we tried to get blood samples. I kept thinking how she should have been intubated and placed on a ventilator the day before. But there were no ventilators. Children don't get intubated here.

I went upstairs to start rounds with my intern, and when we came back down about an hour later, we learned she had also passed away.

I don't want anyone to think that the doctors and nurses and families here aren't unfeeling. Everyone was upset. But child deaths are not uncommon here, especially for young babies, so it's not necessarily a tragedy, it's just another part of life. We carried on with taking care of and admitting other children.

In the afternoon, I sat in the ICU. The curtains had been drawn around the baby's bed but I could still see the small wrapped bundle laying on the bed. Then a man and woman came in carrying a laundry basket. I watched as they gently placed the baby in the basket and covered and tuckered her up with a black cloth. The nurse asked the mother, still caring for the other two babies in the ICU 2 beds away, if she wanted to see her one last time. The mother said no. And then they carried the laundry basket away.

I knew this was something I would likely encounter here. In fact, it's partly why I came here. To learn from and help with and see the difficult cases. But it hurts so much. It hurts that children dying are not uncommon here. It hurts that both of these sweet baby girls would likely still be alive had they been in a hospital or country with better resources. I don't even know how to describe exactly what I'm feeling but I don't think I'll ever get the picture of that laundry basket out of my head.

I apologize to anyone reading this. It's not fair to put this burden on others but I needed to say something for my own sake.

And I also hope it may serve as a reminder of just how lucky we all are. So go hug your loved ones a little tighter for me please.

Tanzania, Can't Wait to Meet 'Cha!

It looks like it's been quite a well since I posted anything here. I don't really have a good excuse other than, you know... life. It's been more of a 'processing things in my head rather than writing things down' kind of year.

BUT, that will change shortly, because...

I'm going to Tanzania for 7 weeks!

I mean, I couldn't really finish up med school without at least one more big adventure under my belt. You all know how I am...

I'm leaving at the end of this week and will return mid-end of March, right after Match Day actually (ahhhhhh).  I'll first be spending 5 weeks on a pediatric rotation in Arusha; which will include working at both the main hospital and rural clinics in the mornings and the Child Growth and Development Centre in the afternoons. I'm particularly excited about this since the CGD focuses on HIV prevention through education, while also working to address the many orphans that HIV has created in the community. The organization partners with groups of Maasai women who have taken children without families into their care. My work there will include the preparation of educational materials that will help to provide the women’s groups with additional skills through training, monitoring the children and charting their health, and assisting with outreach efforts that will help to raise the visibility and profile of CGD as an organization.

Once the program is complete, I plan on sticking around for another 2 weeks to climb Mt. Kilimanjaro (or at least try... but it's right there guys... how could I not?!) and then spend the duration of Match Week in Zanzibar trying not to panic. And hopefully a Serengeti safari will happen at some point while I'm there too.

And to make things REALLY interesting... I'm going to be by myself. I have never had a problem traveling on my own (it's always scary, but enjoyable at the same time). But I will essentially be living and working on my own with all local docs while I'm there; no other students or international volunteers will be with me. This should hopefully mean that I will able to really be immersed in the experience and the local community but it will be incredibly challenging all the same.

No matter what, I'm really looking forward to this new adventure and am so grateful for another global health opportunity since it's something that I feel so passionately about and plan on making a part of my career for a long time. I also can't wait to see how I can apply what I learn to experiences back in the US medical world.

Since I plan on posting lots of pictures and updates on here throughout my time there, feel free to follow along!

Soundtrack of 2015

Can you believe it's 2016 already?! I know, I know, that's what everyone says. But, seriously. I'm more than half-way done with medical school... when did that happen?!

I don't plan on starting this year off with anything quite as drastic as last year (although that pink hair may make another appearance at some point... you've been warned), but I did want to put at least a little "New Year" something in my tiny corner of the internet. 

So. I'm probably a little late with this, but I thought I would share some of my favorite 2015 albums. But I don't mean the albums that I thought were "the best" of the year. These are the new albums that held some kind of significance for me this year --  the songs that were played on repeat to keep me from losing my mind studying for boards, that drowned out disappointments, put words to unprocessed emotions, kept me company on runs, car rides, and travels, and simply helped weaved together all of the memories and stories I have from this past year. So, in a sense, these albums and songs were my 2015 soundtrack.

This post may seem a bit self-centered, but I figured that if these albums meant something to me this past year, maybe they will mean something to someone who may read this for this new year. 

Interestingly, some of my new finds at the beginning of last year, stuck with me all the way through. Certainly makes me excited for new discoveries this year! 

Okay, here we go, in no particular order:

The Balcony - Catfish and The Bottlemen

Oh man, I listed to this album so much this year. Whether studying, driving, or running, and in times of frustration, happiness, sadness... whatever and whenever. I think it will be on regular rotation for me for a long time. There seriously is not a bad song on it (although personal favorite is still Cocoon). 

Our Own House - Misterwives

This was another album that I listened to constantly, in all types of moods and circumstances. And a big highlight of the year was getting to see them play live back in November with a dear friend. For some reason, it serves as a reminder to me to just have fun and be myself, other people's opinions be damned.

If I Was - The Staves

This album is so incredibly beautiful, yet so simple. These songs kept me company through both late nights and early mornings. They have stuck with me so much that I even find myself humming the melodies while walking around the hospital. Plus, I think I've said before, but their cover of "I'm on Fire" is an absolute must-listen.

Chaos and the Calm - James Bay

I love that this album has a little bit of everything. It just feels incredibly soulful to me. So much singing in the car with this one.




Live at Carnegie Hall - Ryan Adams

Not much explanation necessary here. This had me cracking up in the library during boards time, which is also ironic since most of these songs are beautifully sombre. But if you have listened to all 3.5 hours of this, then you understand. Ryan Adams' version of 1989 also gets an honorable mention.






Speaking of honorable mentions:

        


        

       



Okay, that's a lot of music. I kind of wish now I had done this for 2014 too (Hozier, Little Chief, little hurricane now that I'm thinking about it)!!


Hopefully this has inspired you to think about the songs that made up your 2015 and all of the memories that go with them.

Here's to a new year with lots more music and adventures!

She Was My Patient

She was my patient. A few months ago I was assigned to follow her case while on my General Surgery rotation. I was still only a mere 6 weeks into my transition from classroom med student bent over a book, to clinical rotation med student trying to figure out what the hell I was doing. As students, we are generally assigned only 1-2 patients at a time so that we can closely follow their hospital course. So she was my one patient.  

I saw her every morning and evening in the days leading up to her surgery. I scrubbed in on her surgery, which was completed successfully with no complications. I helped the nurses clean her up after surgery. I encouraged her to get up and out of bed even though it was hard because I knew it was good for her. She was my patient. 

But she was also a sad and lonely woman. So much so that when I was told to go home after a 14 hour day, I stayed and sat with her for a while, just to try to keep her company. We talked about her children, we (she) watched Fox News, and I chuckled as she explained to me that Donald Trump would make a great president (full disclosure: I asked her if she thought his hair was real).

Two days later, she was declared to be stable and ready to go to a rehab facility to gain more strength back before going home. I said goodbye to her, knowing that she probably only had a few more years at most left, but that she would at least get some more time with her family.

Three days later I came in to the hospital in the morning and learned that she had been brought to the Emergency Department in the middle of the night. She was currently unconscious in the ICU. By the end of the day, it became clear that despite all of the resources of the medical team, she probably wouldn't make it through the night.

I don't think we'll ever know what exactly caused her downward spiral. There may have been an accidental overdose of one of her medications, her body may have been too worn out to metabolize her medication, or she may have just plain started to shut down. No matter the problem, there was no way to fix it.

Despite the fact that nothing else could be done for her, she remained a "Full Code" as a result of some legal disputes within her family. This meant that we had to continue to pump her full of drugs, keep her on a ventilator, and when the time came, do CPR and any other required life-saving measures. 

She was my patient, and I felt completely powerless as I watched her body slowly shut down, and her suffering was prolonged. After three days, her body was in a condition that I hope to never see another person in again. When her blood pressure and pulse no longer became detectable, a code blue was called.

She was my patient; someone I tried to help heal, and so I made sure that I was there when the time finally came to end her care.

Despite being trained in cardiac life support, I had never been a part of an actual code before. I watched as the nurses and doctors set to work doing compressions, administering medicine, and searching for a pulse on a person who was already gone and couldn't come back. A pulse returned twice during the course of the code and both times everyone in the room let out a sigh, as if to say: "Why can't this poor woman just go in peace?"

As a medical student, the only thing I could do to help were chest compressions. When the time came, I stepped up on a stool, legs shaking, and put all of my energy into pressing on her chest. The nurses kindly told me I wasn't pressing hard enough, so I tried harder. 

I was disgusted with myself. I was making this poor woman, someone I knew, someone who just a week ago told me that "of course Trump's hair is real", suffer even more, solely for legal reasons.

I felt like I was doing harm.

When her death was finally pronounced, everyone in the room breathed a sigh of relief. The nurses asked me if I was okay, that I looked so sad. "She was my patient."

I have had a lot of difficulty processing that day. I've been told that everyone remembers their first code, that everyone remembers the first time they lose a patient, that we all go through it, it's just how things go, and that I knew this was going to happen when I went to medical school. All of this is true, but it doesn't necessarily make it any easier. I didn't think my first code would be my first patient death, and I didn't think it would be for someone who had zero hope of surviving. I wanted to go in to medicine to help people. I made a pledge to Do No Harm, and I felt as if I had gone against that.

Since that time, I have partaken in two other codes, both within the past few days. One had a good outcome, the other did not. But in both cases, we were fighting as hard as we could to get a heartbeat back because we could get it back. Because these people were still there, people with families and friends and lives to keep living.

And so when the time came for me to do chest compressions, they went from seeming barbaric and cruel, to the most humane and human thing someone can do. I was putting every ounce of energy, everything I had, into keeping their hearts beating for them. 

Even though I did not know either of these patients prior to the code, it is still never an easy thing to see another human being in that condition. It will never be easy to watch someone's life come to an end. 

I have often worried how I will keep a healthy balance of emotions as I go on in my medical career. How do I keep my empathy and compassion without letting them consume and cloud my medical ability and my life outside of medicine? How do I not get weighed down by the unhappy outcomes without becoming numb to them?

I got the chance to ask my attending this question after one of our recent codes. He explained to me that unfortunately many people tend to take life for granted until it is too late. People may have regrets about the way they lived: goals left unachieved, dreams remaining just dreams, truths never told. He said that as physicians and caretakers we have the extreme privilege of witnessing moments of mortality on a daily basis. We see lives ended too soon and unexpectedly. We know to not take life for granted. 

She was my patient. I will have many many other patients. I will lose many other patients. As a physician, I will see moments of pure despair and pure hope. But I know now that I can take all of the sadness I see and rather than let it weigh me down, let it be my reminder to keep going: to keep enjoying life, working hard, and not take anything for granted.

New Music for the Summer

Hello!

I have come out on the other side of step 1 of my board exams.. also known as medical student hell, and started actual rotations. Um, whoa. I'm still in the midst of processing boards, moving out of Philadelphia for the next year and starting working in the hospital (in Psych!), but hopefully I will share some random, funny stories and maybe even a little insight in the next few months.

In the meantime, it's summer, and I figure everyone can always use some new summer jams so I wanted to share my favorite recent discoveries that have been clogging up my spotify playlists, focusing mainly on some kick-ass women (does anyone else find it easier to curse in writing than speaking?).

I'll start off  with the album that I would pick if I could only listen to one for the whole summer:


"California Nights" - Best Coast

Best Coast has made a few albums reminiscent of surfer 1960's meets girl rock, but their new album, California Nights, also has a 90's alternative feel.

The songs progress how I imagine a day in the California sun would; from the steady, upbeat, let's-get-this-day-started "Feeling Ok", through the mellow, sunset-vibes of "California Nights", all the way to the restless end of the night with "Sleep Won't Ever Come".






"My Love is Cool" - Wolf Alice

If you are more of a London grunge-rock kind of person, then look no further than Wolf Alice. This is a band that has been getting a lot of love lately, I'm just sad I didn't jump on the bandwagon sooner!

Perfect blend of rock, alternative, edge, and cheekiness.






"Sometimes I Sit and Think, And Sometimes I Just Sit" - Courtney Barnett

Speaking of cheek, Australian rocker Courtney Barnett has tons. I can't help giggling as I listen to her fun and intelligent lyrics.

 (Apologies for the clown)

"If I Was" - The Staves

I first came across this trio of sisters a few years ago with their debut EP, "Mexico", but then they kind of fell off my radar unfortunately.  But they once again have my full attention with this new album, produced by Justin Vernon. The harmonies and melodies are stripped down and insanely gorgeous.

Live Cover of "I'm on Fire" - not on the album but had to share

After a long day of playing out in the sun, listen to this under the stars, next to a fire, maybe with some s'mores. Definitely with s'mores.

I know I said I was all about this ladies this post but I would feel incredibly selfish if I didn't share these other two new favorites...


"Coming Home" - Leon Bridges

You may listen to this album and think it was recorded in the 50's or 60's with the likes of Sam Cooke but I assure you it was only released a month ago.

Leon Bridges nails the 60's soul, blues vibe while still keeping his own modern twist. This album makes me so happy.






Moon Taxi

This  Brooklyn-based indie alternative band was a lucky discovery when I was at Governor's Ball last month (speaking of, Florence + The Machine: holy cow that woman is not human). None of us had heard of them before but we happened to catch them while waiting for the next set that we were planning on seeing- instantly hooked!

Their 2013 album "Mountains Beaches Cities" is addicting so I'm really looking forward to their upcoming release!




Okay, back to reading about personality disorders! Feel free to let me know what music you've been loving this summer!

Also this: