1/27/18

This morning from 7am-10am (which corresponds to 1-4 o’clock Tanzanian time given the day starts at sunrise) we rounded on only the sickest patients and helped “clean”.

One day a month the entire country of TZ is now mandated to clean for three hours one Saturday a month (per the new government). This includes hospital staff; no one is known to be exempt. Many men used long scythe-like tools to hack down grass (their version of cutting grass) and females cleaned indoors.

We are now down to 10 people in our group, this will be unchanged for at least another week.  Many of us go for a walk/run as the sun rises each morning. When not cloudy the view is incredible. Our breakfast over the past few days is unchanged, consisting of mostly carbohydrates. This has been more tolerable recently as we’ve cut up ~5 mangos daily to eat each afternoon.

We received a phenomenal 2 hour introduction to Swahili course taught by a local named Joyce.

Yesterday and today on the general medicine wards we saw interesting/heartbreaking patients.  In regards to the general wards (which do not include outpatient clinics or obstetrics/L&D), there are separate rooms/units for general pediatrics, children with malnutrition, infants with breast-feeding mothers, patients with known/suspected pulmonary TB, HIV/AIDS positive patients, and adults with uncomplicated illness. Men and women are always in separate rooms.  There are far more adult patients then pediatric patients..

Recently the hospital has been filled to capacity; yesterday there were reportedly 23 admissions over 24 hours.

Some of the patients over the past day include a 4 year old HIV+ boy with SJS of his face/eyes (a drug reaction to HIV medication resulting 2nd-3rd degree burn-like injuries) and bilateral secondary orbital cellulitis, 2 year old orphaned severely malnourished boy with kwashiokers, a middle aged rice farmer with presumed moderate systemic schistosomiasis and marked anemia from a GI bleed, a new diagnosis of pulmonary and extra-pulmonary TB (in the setting of not completing TB treatment a few years prior), a middle aged farmer with acute encephalopathy and lower extremity paralysis/paraparesis concerning for  Guillan-Barre vs B12 deficiency vs viral encephalopathy, a new diagnosis of acute/chronic liver injury with marked jaundice, a 25 year old female with acute onset mutism and probable new diagnosis of bipolar affective disorder, a 30 year old female with mutism and probable new diagnosis of schizophrenia, and 5-10 cases of complicated malaria and diarrheal illness. I was surprised to learn that mutism seems to be a common presentation of psychiatric disease.

Of note, two days prior I met with Pastor Nixon Mwitula of Iringa. He is finishing his training as a combined psychiatrist/psychologist; his University is the only training program in TZ mental health. He had a lot of insight into the minds of Tanzanians and shed light onto why mental health, substance abuse, and domestic abuse are so neglected in TZ. Our conversation was slightly reassuring.

Previously, when I asked one of the head physicians in Ilula about mental health and addiction, I was told, “there is no addiction, not here in Ilula”. Those with chronic or transient mental illness are termed “crazy people”. On the wards mental health, substance abuse, and domestic abuse are not addressed; they are rarely even acknowledged.  The lack of awareness/education about these subjects by all Tanzanian healthcare providers is astounding. In addition, even if mental/social health were to be touched upon treatment, psychotherapy, and behavioral therapy are not available. In regards to these issues, it seems TZ is ~50-100 years behind the US.  It was comforting to discover there was at least one University or location to address mental health and addiction (Iringa).

Also of note, we had a long discussion yesterday about the state and progress of Ilula’s hospital. We recently visited Tungamalenga dispensary, which had remarkable cleanliness, documentation, record keeping, and organization. This is superior to that at Ilula despite having fewer resources.