Posted on behalf of Danielle Brueck (PL3)
The task of trying to capture in words all the sights and sounds of this place is daunting. The days have started to carry much familiarity yet never quite enough to feel like home. Tanzania - as a country and as a people - is beautiful. I have felt very welcomed and am grateful to have this opportunity.
In an attempt to capture the experience of the past month, I will walk you through an average weekday. Please allow for some creative licensing on my part to help condense the experience of many days down into one day, recognizing that each day is not actually as glamorous or exciting as this may lead you to believe.
6:15 am: Wake up. Eat some toast and surprisingly good peanut butter.
6:45 am: We are supposed to be leaving. I am living with Emily Hall (Peds Resident - PL3) and Caroline (Medical Student from Holland). I realize I am the only one actually ready, probably because I wake up the earliest every day. Then I realize this is because Emily and Caroline can actually walk much faster than I can and plan to make it to the hospital in less time than I thought possible.
6:55 am: Actually leave our place and set out on our 7 km hike to Selian Hospital (uphill both ways, obviously). During our walk, we have the excellent opportunity to practice our Swahili with the school children who are walking along the fairly car-devoid back road. We are met with "mzungu" (Swahili for white person) and "how are you?" and are spontaneously hugged or touched. This is often followed by much laughter from the children.
Walking to Selian Lutheran Hospital
8:15 am: Arrive at Selian and attend chapel. The singing is beautiful and allows us all some time to relax after the long walk. Chapel is attended mostly by the medical staff (nurses, interns, etc.) of the hospital, and they are most welcoming to us as we fumble to figure out which hymn number we are supposed to be singing.
Selian Lutheran Hospital
8:45 am: Morning Report starts which entails a brief reading off of the admissions, discharges, and deaths for the past 24 hours. I hold my breath a bit, hoping that the neonate with seizures and hypopnea is still alive. He is not called out when the deaths are read, and I feel relieved. An interesting admission of a patient with sagittal sinus bleeding after trauma is discussed.
9:00 am: X-ray rounds. The power is out so we step outside to view the x-rays in the light of the sun. Interns take turns giving their impression of the films - pneumonia, congestive heart failure, femur fracture.
X-ray Rounds at Selian Lutheran Hospital
9:20 am: Round in the ICU. There is just one Pediatric patient with likely bronchiolitis but requiring oxygen therapy. We check her vitals and finagle the adult pulse oximeter to pick up a reading on the child's foot. She looks better today. Perhaps this whole bronchiolitis peaking on day 5 thing is true here too. Maybe I have learned something in residency; I feel excited that Emily agrees that the right upper lobe infiltrate on the chest x-ray could just be shifting atelectasis.
9:40 am: Chai break. Besides, they are cleaning the hospital floors. I begin to wonder whether it is a worldwide phenomenon to clean hospital floors during prime rounding hours. Oh well, chai sounds great. And the floors do need cleaning.
10:00 am: General Pediatric Ward rounds. Emily and I are working with a fabulous intern and his supervising equivalent of a senior resident. We grab the paper files (charts) which the nurses have neatly stacked for us and the equivalent of a WOW (workstation on wheels) which is a huge cart with drawers filled with cotton swabs, discharge forms, pulse oximeter, etc. The children, many of whom have been sitting outside in the grass, trickle back into their beds as they realize we are starting our rounds. Some of the patients come with complaints that are familiar to us - chronic constipation, bronchiolitis, diabetic ketoacidosis. Yet we are also challenged with more unfamiliar cases - Kwashiorkor malnutrition, cutaneous anthrax, tuberculosis. We scratch our heads a bit about how to treat diabetic ketoacidosis with subcutaneous insulin and not an insulin drip. The patients , their parents, and our fellow Tanzanian colleagues are kind and patient with us, answering our many questions. The intern is eager to learn, explaining to us how he has been taught to approach a problem and then asking questions about how we would approach this problem. The more senior resident helps guide and make management decisions on each patient.
11:30 am: Baby checks. We head over to the obstetrics unit and inquire if there are any neonates with acute concerns. Two are currently being treated for likely sepsis with a presentation of fever and increasing fussiness. There is no microbiology lab or ability to grow cultures so empiric therapy is given. We are happy to see that the neonate with seizures and hypopnea is much improved today. After seeing the neonates with acute concerns, we also do a routine exam on all new babies.
12:30 pm: Lunch of rice and beans.
1:30 pm: Follow up on interventions, labs, imaging.
3:00 pm: Time for the long trek back home. I think I am in better shape than I have been since residency began. Maybe I will walk to work in Minnesota. Then I remember it is at least 40 degrees colder in Minnesota, and I take that thought back. We stop at a roadside stand along the way to buy some fresh vegetables for dinner.
4:00 pm: Arrive home. I am grateful we have such a wonderful place to stay with fairly consistent/reliable internet access. Check emails, read.
6:00 pm: Time to make dinner. I realize the great amount of time and energy that this can require and remember why I cook so seldom at home. I envision the many canisters of beans at our apartment in Minnesota and recount the innumerable times we have vowed to use these. We all enjoy each other's company in the kitchen as we cut up our fresh vegetables and cook some rice and beans. We actually sit at the kitchen table to eat and don't feel rushed to a flurry of other activities.
10:00 pm: Time for bed. I am starting to enjoy this whole sleeping thing.
There are already many exciting memories from this place, and I am eager for more to come as we finish up our second month here. It has been a pleasure to work with, and learn from, our colleagues here. I continue to think through how global health will have a role in my career moving forward. Regardless, opportunities such as this strengthen my clinical skills, offer new perspective, and challenge my ability to think critically. I am hopeful these moments will become a part of how I practice medicine and allow me to provide better care to the children I encounter, regardless of location.