A much different day at Ilula

 Although we could consider today pretty routine at Ilula for what we saw and did, it was much different than Sunday.

I do not always go to devotions, but did today. Pastor Kikoti leads and prays and sings. After all these years, though I do recognize hymn tunes and a few words, I still do not really know what he or anyone else speaking Kihehe or Kiswahili, is saying. I learn some vocabulary each visit and some phrases, but no grammar. I am sure the pastor is patient with us wazungu, if not indulgent. Indulgent would be speaking in English, which he knows, or translating along the way.

The group is still at Ruaha National Park and will be home tomorrow evening. Mwamoody, Dr. Gary Moody’s Hehe name, flies out in the morning and will be joined at Ruaha by several of our group. Mwamoody means head of the Moody clan within the tribe, though not quite chief. Regardless, it is a title of esteem bestowed on him.  He has earned it, learning considerable Kihehe and Kiswahili over years.

After Morning Report, which I find leaves a little to be desired, we went on rounds. I think Morning Report is much drier than it needs to be. Many of the statistics are posted on the board, so the report is also redundant and repetitive. (Did you see what I did there?) But there is a little time spent on troublesome cases and deaths, and not dry at all.  The doctors and others ask questions and discuss the case.  This is similar to report that we do at home. Now if we could just skip the redundancies. Oh well, it is their report.

 

Deo, head nurse of the General Ward.

I went off to rounds with Dr. Shangwe and Dr. Glory, two bright young women doctors. (By the way, I have a right to refer to them as young!)  We were in the Post C-section ward. Everyone was doing well and only one patient to a bed at the moment. Here is an odd situation. Technically, mothers delivered, whether by C-section of vaginally, are supposed to be covered financially by the government, along with children under five years and the elderly (that means over 60!). One mother had been in the hospital for the 7^th day.  First, I do not think that everyone understands the coverage, but the story was that she was waiting for someone to come and pay her bill. Sounds like debtor’s prison to me.  I do believe there is some element of patients voluntarily paying what they can, however. What I have heard before and choose to believe now is that she has stayed a long time due to her home being at Image (pronounced ee-mah’-gee, not im’-aj, as in English), which is a very long distance away. This is just a quirk of distances, quality of roads, etc.

I saw Michael and Dr. Benjamin pass by the window and went to be with them. I spoke with one of the ward nurses for a bit and then joined them at the bedside of an undernourished baby. We had some conversation about the various formulas and Plumpy’Nut, also a Ready to Use Therapeutic Food (RUTF). Of course, I whipped out my MUAC tape and asked to measure this pretty little girl’s arm (Mid Upper-Arm Circumference). And yes, she was in the yellow, fortunately not the red. She was with grandma (Bibi) as mother had died in child birth with her.

We saw several challenging cases, but the most challenging was a young woman with KS, Kaposi’s Sarcoma, a malignancy now nearly exclusively found in patients with AIDS. It is treatable, however, the drugs are not available at the level of the Council (or District) hospital.  Essentially, we cannot treat her. Dr. Benjamin presented her with the option to be transferred to the Regional Hospital in Iringa, however, even the Regional Hospital has no access to the oncology drugs. She got the prescription and first round of drugs at a private hospital, Tosamagonga, but we cannot transfer laterally, i.e. to hospital in the same category as our own, only upward.  That hospital is truly “private,” whereas ours, as a district hospital needs to play by the government’s rules (if we could, in fact, get the drugs).

So here is the medical culture shock question: what do we do if she chooses not to go to the Regional Hospital?

Our colleagues do face situations similar to our own. We saw two patients, one 98 and one 101, near death. Both were offered tube feeding. I think the loved-ones both chose “no.”

Challenges will continue tomorrow. I am sure our residents and pharm students will have their own perspectives and equally dramatic stories.