A final Asante from Ryan as he finishes his rotation in Tanzania

Posted on behalf of Ryan Fabrizius from March 6

 

Jambo from Arusha (actually waiting in Dar es Salaam airport at the moment)! 

 

Today marks the beginning of my journey back home. The past two months have so quickly passed, and this week has been a one of good byes and thank yous. I had the chance this week to do some home visits with the Hospice team. Unlike American Hospice care, the hospice team at Selian visits home-bound patients regardless of their life expectancy. For example, most of the patients that we saw have HIV infection as their primary debilitating illness, which, we hope, will not be life limiting if they are able to receive their medicines and routine HIV care regularly. The particular patients were selected because of their poor overall condition and lack of family support and resources. It was a wonderful chance to see a broader picture of the daily experience of these patients, seeing their homes, families, and neighborhoods. In health care, we life to think that the clinic appointments, hospital visits, and medicines prescribed make a big difference in someone's overall health, but seeing the patient's living conditions and imagining their daily life, I can see how far downstream we are from the roots of their problems. 

 

The last word in this series is actually one I have mentioned before, but it is so nice I'll use it twice. "Asante", as I have mentioned, means thank you. I have so much to be thankful for at the end of this two month experience. It has been a great joy to work alongside the Tanzanian medical staff at Selian, to experience their hardships, the challenges to caring for patients in this environment, and the camaraderie of sharing our knowledge, experiences, and goals. To let me follow along on their hospital and clinic rounds, my Tanzanian colleagues gave up their time and departed from their routine. But on top of that, I feel more than just a collegiality was fostered, that it was a lasting friendship. For that, I am thankful. Asante does not seem to explain this gratitude deep enough, but it is the best that I had to offer in return. Asante has been offered so many times during my stay here, both from me and to me. It is often for ordinary services, such as at a store or restaurant. It has been offered from our patients, often the most fervent "asante" coming from the patient and family for whom we have no good option to left. However, when I consider how much I have received during my time here, I wish I had more than just one word. I wish I had the power to help my friends accomplish their goals. I wish I could take the stories that I have seen and strike the problems at their roots. I wish we could all have equal opportunity to quality health care and the basic needs that would sustain that health. But for now, I offer thank you, and resolve myself to not forget what I have seen and the people I have shared life with here in Tanzania.

News from Laos and an U/S Project with Patricia & Junaid

Posted on behalf of Patricia Hickey (PL3) and Junaid Niazi (MP3)

Sabaidee from Laos!

Junaid and I are halfway through our rotation working with local Pediatric residents. Our role is to discuss patients with the residents and teach, as well as learn. These residents are completing 3-year residency programs developed by Health Frontiers, a group based out of the US. The residents are supervised on the wards by excellent Lao “teachers,” as they call attendings, and are also supported in their education by the Health Frontiers coordinator, currently a congenial Australian pediatrician. Visitors like us come from countries all over the world to contribute and learn. The Lao teachers are more patient with random foreigners coming to teach than I think we might be in the US. They trained at a time when resources were even more limited and the country was much more isolated from the rest of the global medical community but they are very competent and experienced. The mob of white coats on rounds is even more impressive here than at St. Paul Children’s as there are more trainees per team here. So there is plenty of teaching to go around...for the most part. This week it turns out most of the residents are attending seminars given by German Neonatologists so there is less for us to do. We can’t participate in patient care directly because we don’t speak Lao and don’t have Lao medical licenses.

Rounding

We arrive at the hospital in the morning after the residents have completed their morning report (in Lao) and most of their rounding. They are usually busy filling out fairly extensive paper charts and writing paper orders, which parents take to the pharmacy/radiology/etc to pay for each item of care ahead of time, be it an X-ray or antibiotic. The residents take turns presenting “interesting cases” to us - which as far as we are concerned is all of the cases. Even if it’s something we've typically seen, such as gastroenteritis, there are always discussions to be had about different management in areas with different epidemiology and different resources. Many of the cases have been especially interesting because they represent very late manifestations and advanced disease. There tends to be an additional element of mystery because of the frequent lack of diagnostic tools available. I think sometimes we have had the benefit of correlating history and physical more closely with diagnoses because of the extensive workups our patients have in the US. For example, here they may never know that a patient has Tetrology of Fallot because there is no Pediatric Cardiologist in the hospital and if the patient is too sick to be transported to radiology she won’t get an echo. There is a 6 month old baby here who I suspect has TOF but his last echocardiogram (performed by an adult Radiologist) months ago was read as large ASD which would not explain why he is in heart failure and has a palpable thrill.

The hospital

Resources here are changing frequently as Laos is a country in the midst of change. Construction surrounds us at every corner, from before dawn to well past sunset. We eat croissants for breakfast, walk to work dodging streams of shiny cars, and blend in with crowds of backpackers on our way to the hospital where there is minimal air-conditioning. Where you can be intubated but cannot obtain blood gases or portable chest X-rays. Where you can get a head CT but not an albuterol inhaler. Where we found a brand new ultrasound machine in the PICU untouched because no one was taught to use it. We have discussed the basics of bedside ultrasound with some of the residents and are working on a developing a “how to” guide, as well as planning several practice sessions. I am sure adoption of this technique will require much more reinforcement by people more qualified and more consistently present than we are but hopefully we have at least introduced the idea. This has the potential to be an incredibly valuable tool where portable imaging is not available and imaging in the Radiology department is not always affordable or attainable. We are grateful that we literally stumbled across this project and excited that several residents seem eager to learn bedside ultrasound. Before we leave Laos, we want to ensure that a procurement system is in place for ultrasound supplies—the gel, photo paper for printing images, etc. If we can accomplish this, then we will have given back a tiny fraction of what we have gained from this experience. Until next time!

Patricia & Junaid

Junaid Niazi, MP3 & Patrica Hickey, PL3