19/1/16

This morning Aaron gave a little talk on organophosphate poisoning at morning report. It was a delicate subject because the evening before a patient had died from organophosphate ingestion. However, I think it was well received by the Tanzanian staff. Although they aren't well acquainted with the idea of a morbidity and mortality meeting, I think it was a useful conversation to have. In the US we use M&Ms as a way of internal quality improvement to learn from our mistakes. We hope we can inspire a culture of teaching and continual learning here that will be locally led and sustainable. 

After rounds Hindi, Katie and I prepared to go on mobile reproductive and children's injection rounds at a town about an hour away. Around 930 we packed into the Land Rover used for palliative care and started out on the road to Image. We had a few stops along the way to pick up some nurses as well as some women and children who hitchhiked in the back of the truck with us. After about an hour and a half of driving on the muddy red dirt roads we arrived at the village. We were at the base of the mountain we can see in the distance from our house and the scenery was incredible. Outside there were babies and young children being weighed from a scale hanging from a tree. The babies were put in katangas to be weighed and the small children in overalls. Our injection clinic was held in a small building off the side of a church. The patients came in one by one with their cards listing their previous injection dates. I was surprised that the immunization schedule was very similar to that in the US and most of the babies were well nourished. A couple women came in for depo-provera injections as well. They ranged in age from 20 to 40 and all had other children. Despite the language barrier we learned a lot of Swahili phrases from the nurses running the clinic and were impressed with their efficacy. After a couple hours we packed up our supplies and headed back to drop the nurses off and periodically stopped to drop off the other hitchhikers who were going in the same direction. 

In the afternoon a few of us went back to the hospital to check on a infant who was admitted earlier with severe dehydration and a fever. After examining him we called the clinical officer on call and suggested some medication additions and oxygen to possibly improve the patient's chances of recovery. The only thing we can hope for now is that he makes it through the night. We have to treat most infectious processes here empirically due to our laboratory capabilities. With broad antibiotics, IV fluids, and corticosteroids we hope we are covering most diseases that could be causing the baby's severe condition. 

The evening was consumed with walks and dinner with the hospital administrator, Kikoti, as our guest. Ken Olson also arrived today so we had a full main house. Anna, our cook, made an excellent dinner again and we spent the rest of the night talking about our day and experiences.