Home sweet home :)

Sorry for the late post, but we made it home safely last week in one piece. =) It has been great to be home and see friends and family, but it's definitely going to take awhile to decompress and put some final thoughts together about our experience.

In the meantime though, we had a great time on safari and were really blessed to have such an amazing experience. We saw pretty much everything except a rhino and had some fun encounters at one of our campsites with zebras, an elephant and a bushpig. All in good fun though! Nothing dangerous. We also got to see 4 lions stalk and kill a gazelle which is apparently a pretty rare occurrence so that was pretty neat! Our guide and cook were amazing and really made our safari fantastic.

I hope that everyone is doing well and enjoy the pictures!!

Lions, Cheetahs and Leopards... OH MY!!

Well we've finished our time at the hospital and have managed to unload the 3 large suitcases full of supplies that we brought. I spent one last day in surgery yesterday and observed a successful excision of a lipoma (benign fat tumor) from a woman's clavicle and an above the knee amputation turned hip disarticulation. The lipoma excision was the first time I actually saw them use a general anesthetic for a surgery. Most likely because of the proximity to her head. For the most part, the surgery went quite well and the surgeon very skillfully removed the lipoma being careful of all the nerves and arteries that could have been nearby or wrapped around in the tumor. The anesthesia wasn't exactly top notch, but they do have limited supplies to work with and are also probably trying to conserve the anesthesia gas as well as not put her under too deep since they don't have the means to support her if it's too much. All in all, success.

The amputation was a long process. The elderly gentleman had been in a bike accident either this May or last, we're not exactly sure which, but regardless, his femur was not repaired at the time of the accident and he was now in very bad shape with his lower leg twisted 90 degrees inward from the break and open infected wounds. Dr Lee wanted to do a hip disarticulation from the beginning, but the anesthetist was concerned about how weak the gentleman was from low hemoglobin. They had 2 units of blood ready to transfuse as well as general fluid support. Dr Lee began with the above knee amputation, but once he started trying to clean out the necrotic tissue after removing the lower leg and broken part of the femur, he began having trouble tying off arteries and getting the bleeding under control. Mid-surgery, Dr Lee made the decision to do the hip disarticulation because he was able to tie off the main artery and control the bleeding better from there. The rest of the surgery went quite smoothly as he removed the rest of the femur and dislocated it from the hip joint. He ended up having to cut off quite a bit of skin to get the closure just right. The finished product looked much cleaner than when he came in, but I'm sure it will be an adjustment for him only having one leg. No idea how he's doing post surgery, but I'm quite confident that Dr Lee made the right decision and that he will fare better in the long run.

There is usually very little going on at the hospital on Fridays so we opted for cleaning out what was left of our supplies, donating our scrubs, stethoscopes, hand sanitizers and white coats and saying our good-byes. It has been an incredible experience that I'm sure I will think back to often throughout my training, but I am ready to come home.

We have one last adventure before heading home and that of course is our safari! We head out tomorrow morning for a 3 day safari to the Serengeti and Ngorongoro Crater with Soko Adventures. We've heard great things from people who have used them before and we are very excited. I think one of my favorite parts, besides the animals of course, will be not being stared at and called "mzungu" all the time!

Will try to post one last time before heading home on Wednesday, but no guarantees. It's actually gotten a bit cold here so it will be nice to be home in Portland's beautifully warm weather!!

Kwa heri!!

Coming down the home stretch...

Amazingly enough we have entered our last week at the hospital. I was hoping to be in surgical clinic on Monday but couldn't find dr lee, so I decided to spend a bit more time in the labor ward. It's always interesting being inthere because you're never really sure what's going on or who's closest to giving birth. Many of the women scream and moan for hours on end before they actually give birth and others wander in and give birth as they're setting up their bed without saying a word. On this morning it was fairly quiet except for one loud and exuberant youger woman and after morning rounds there were two women who started giving birth one right after the next. I was able to help get supplies ready and got to carry the baby into the newborn room where they get weighed and then just snuggle under a blanket. The first mom did quite well and was up and walking within a half hour of delivering but the second mom seemed to be suffering from post partum hemorrhage. Several of the nurses gathered around to get an IV into her and start pushing fluids. Once she had been given a full IV bottle, they started to help her up to take her in a wheelchair down to the postnatal ward. As she tried to move from the bed to the wheelchair, she collapsed on the groud at the nurse's feet completely weak from losing so much blood. They put in another IV line and drew some blood to check her hemoglobin count to see if she needed a transfusion. Once she was in the wheelchair and blood had been drawn, I got to help carry her newborn baby girl down to the postnatal ward as one of the nurses wheeled her down. After that, there seemed to be very little going on and the nurses didn't seem very happy to have me there so I headed on over to casualties (aka the ER).

Just after I walked in to the casualties area, a woman was wheeled in looking barely conscious. 4 of us medical students gathered around trying to get vitals on her. We couldn't get a blood pressure and could barely find brachial and carotid pulses. One of the British medical students wandered over to the supply cupboard to find some fluids which then drew the attention of one of the doctors. As she came over, we explained that we couldn't get an accurate blood pressure because it appeared to be so low and we could barely get pulses. She then helped Lindsay to start an IV and push fluids into her as fast as they would go. "This is a resuscitation!" in the words of Dr Janet. Then, of course, when her first course finished, we went to get more normal saline to continue to boost her blood volume, there was no more. So instead of normal saline, we used ringer's lactate, which, fortunately, is a perfectly acceptable substitute.

Tuesday is surgery day. We walked in, changed into our appropriate scrubs and rain boots and got ready to see what was on the schedule for the day. A scar repair and 2 amputations. Sweet.

As the woman came, prepped to get the scar removed from her face, one of the other surgeons came in and started discussing alternative options with Dr Lee. Why wasn't this discussed prior to her laying on the operating table you might ask? Good question. We're still wondering the same thing. She ended up walking out of the OR with the plan of simply getting a steroid injection. Of the other 2 operations that were scheduled, one refused surgery and the other was postponed until Thursday. So we spent the day watching many broken bone reductions and casting.

One of the more involved ones included an older man who has apparently been in some type of motor vehicle accident and suffered a fracture of the calcaneus which is the main weight bearing bone in the foot. The injury was such that there were two huge flaps of skin even though he was now 10 days post accident. Also, the way that the bone broke the Achilles tendon is pulling up on the bone putting it at a suboptimal angle for weight bearing and also decreasing the function of the achilles tendon. Normally, a surgeon would have put a pin through the two halves of the broken calcaneus to stabilize the fracture but alas, this is Africa and mt meru is a government run hospital that is out of supplies.

I spent today rounding with the surgical team and saw one example after the next of decries that need surgery to heal properly but they are out of rods to stabilize femur fractures. There were no less than 50 patients, all with severe breaks that will likely heal well enough but definitely not back to optimal function. One of the patients was being seen for a proximal tibial fracture and had a cast on but he had also suffered a fracture of the radius which also resulted in a dislocates elbow. The complication is that he also had a prior fracture that twisted the bone and didn't heal right. There is really nothing that they can do now as the repair would be a lenghty complicates surgery that they do not have the supplies nor the staff for. It has been A very eye opening experience to see the extent to which seemingly simple fractures can interrupt and ruin someone's life here and I hope that there are things that we'll be able to do in the future to help a bit more.

Maasai village, Zanzibar and back to Arusha...

Pole sana! So sorry for the delay!! We've been without internet for about 2 weeks and there is much to catch up on!! The Maasai village was quite the experience. We were greeted and welcomed like royalty and fed like kings and queens the entire time we were there. It was crazy. Tons of really really good food though. The first night we spent some time talking with some of the village leaders via a translator, mostly Dr Lace talking, but it was very interesting hearing about some of their concerns and also seeing how much they love Dr Lace.

We spent the next day at the clinic and basically saw a lot of malnutrition, pneumonia, eye and ear infections, ringworm and intestinal worms. Almost all of the kids complained of eye pain and difficulty breathing and when we got a chance to go visit one of the huts, we found out why. They live in huts filled with smoke 24/7. We were only in there for 5 minutes and our eyes were burning and we felt like we were suffocating. No wonder they complain of eye pain and difficulty breathing!

Friday morning we woke up to find out that someone had died in the night. Dr Lace and Kurt had gone to attempt milking a cow only to find the women in hysterics and the men talking trying to figure out what to do. They saw the body and the most likely cause of death was that he had had a seizure during the night and fallen off his bed since he was a known epileptic. Dr Lace left clinic early that day and went to help clean up the body and prepare it for the funeral. After lunch we got to witness a Maasai funeral and we were the first outsiders to ever attend a funeral in their village. It was pretty crazy. We also found out that what they usually do is take the body outside the village and wait 3 days, then go back to see whether or not the animals ate it. If they did, it means that the deceased was a good person. In the last year or so, many of the villagers have become Christians and they've started having burials, so this was probably only the 11th burial in the village. Pretty crazy.

Afterwards, everyone gathered to eat together. The men ate separately from the women and children and likely got most of the meat. Thankfully though, we finally got an opportunity to serve them. Lindsay and T went around and washed hands of the women and children and I helped hand out the food. When it came to our turn, we were absolutely stuffed and begged our host, Gladness, to let us feed the kids. Of course she obliged and the children were thrilled to be served by wazungu, white people.

We got a couple chances to walk around the village and just observe and meet people, mostly on Saturday morning when we went and handed out candy and coloring book pages to the kids. It was mass chaos. They absolutely loved us and followed us around in herds begging for more candy. We tried to distribute it as best we could, but it gets difficult to tell who's already had a couple helpings and who's new. We also found out that they think cameras are hilarious and love to see their pictures and we enjoyed toying with them a bit and singing funny songs to them like "In the jungle..." and maybe some Backstreet Boys songs thrown in just for good measure.

All in all, we had a blast and learned a lot. Gladness is doing some amazing things and trying to help the women gain more rights and independence. Our first night there when we were served dinner, the women actually got to eat before the men and then the men had to serve themselves!! Apparently that was a really huge deal and had never actually happened before. Usually women are served after the men and before the children and get whatever's left of the meat which is usually very little. Hence malnutrition being a huge problem. The men also typically have many wives and force themselves upon the women who have no choice as to whether or not they want to participate. They really have no say as to who or when they have sex and whether or not they get pregnant. HIV and STDs are a really big problem and it's difficult to talk about because there's such a stigma attached with it that no one wants to seek help or admit any problems. Female circumcision is also still a huge problem in the village. According to Gladness it's practiced to keep the females from enjoying sex so they don't cheat on their husbands. It's a barbaric method of control and enslavement. However, methods of circumcision have at least improved in that they are starting to use a new clean knife instead of the same one to circumcize multiple children at the same time. It typically takes place for girls between 11 and 13 years of age and for boys between ages 14 and 17.

Zanzibar was a fantastic break and a chance to relax and soak in some sun and delicious seafood. We spent most of our time in the north part of the island where we found a cozy little hostel where we all shared one big bed and took cold showers every day. Not really a problem since it was constantly so hot and humid. Our "innkeeper" really enjoyed having us there and was always joking with us and very nice. He would also climb up a coconut tree near us, knock down a bunch of coconuts, cut them open with a machete and then give them to us to drink the fresh coconut milk and then he'd open them for us to eat the coconut meat inside. It was a delicious treat that I think we're all going to miss a lot!

While we were there we also got to go snorkeling and saw some amazing fish that were almost too close for comfort. We were also served a yummy spicy octopus lunch with rice, a salad and fresh fruit. We also went on a spice tour and got to learn all about the local spices, what they're used for, how they grow and how they process them to be used. It was really interesting and then we were again fed a delicious lunch along with some fruit sampling including some delicious custard apple type thing that I don't even know how to describe.

Stonetown was also pretty amazing and we got to take in most of the sights in one day. We got to see the spice market, fish market, meat and chicken markets and then we went to the Anglican Church which is the sight of the former slave trade. It was pretty eerie walking around a place where so much violence has occurred. I took quite a few pictures, but it's really nothing compared to seeing the shackles and holding chambers for yourself. We also went to the night seafood market and got to try some really delicious shark, baracuda, lobster masala and the ever so fantastically amazing zanzibar pizza with nutella and bananas!

We got back to Arusha on Wednesday night and went back into the hospital for Thursday and Friday. Since we hadn't been into the casualties (ER) area yet, we decided to check it out. Not a whole lot going on, but it was a pretty big wake up call seeing them remove stitches on wounds that still were not fully healed, brutally shove a girl around who had just been unconscious and leave a guy laying on a bed for 20 minutes who had been brought in on a stretcher and didn't seem to be conscious. We later found out that he had fallen down a well, but we didn't get much more of the story or the extent of his injuries than that. Mostly seeing how they treat patients here makes me so thankful for the care and compassion that we have in the states. We went to a talk hosted by Dr Lee on Thursday and they even mentioned during the talk that one of the huge obstacles to care here in Tanzania is the attitudes of the staff and the lack of supplies. I think that's been the most frustrating thing about being here, there is a HUGE lack of care and concern for patients as human beings. It's hard to know how to help change that attitude.

A great example of their lack of supplies is that apparently a man had come in just after we left from an accident with a bus and he had 2 transverse fractures of the femur, one proximal and one distal, both completely displaced, transverse fractures of the tibia and fibula on the same leg as the femur fractures and a fracture of the tibia on the other leg. Obviously this guy needed surgery immediately to stabilize the femur. However, doctors and hospital staff had already left for the day AND, they didn't have rods, nails or screws to do either internal or external fixation. What I gathered from the conversation was that he had to be transferred to a private hospital where he is likely going to be unable to afford the care that he needs. It was a very sad story to hear, but just goes to show how important it is to have supplies and staff that are available.

I think that's all for now, but hopefully that gives you a pretty good idea of what we've been up to for the last couple weeks!! We have one more week at the hospital before we go on safari for 3 days and then a couple days in Arusha to do our last shopping for souvenirs and then it's time to head home. Crazy to think that we'll be back enjoying the comforts of home in less than 2 weeks!! We are definitely enjoying our time here but are getting excited to be back home.

Hope everyone is enjoying their summer back home!!