Busy week!

Well, it has been a busy week. Monday was my first day with the palliative care team - in the morning they oriented me and 3 visitors from Iowa who are here with an orthopedic surgeon on a medical mission. Their group is called STEMM - Sioux City Area (Something) Medical Mission - they have the surgeon and a number of people from several church congregations that are building a village for some orphans and then some that are visiting orphanages and things like the palliative care program. Monday afternoon we did 2 home visits - both to extremely frail cancer patients with open wounds for dressing changes, food and supply delivery, and they sing a song and pray at the end of each visit with the evangelist. (Pastor)

Tuesday was more home visits and then - OBAMA NIGHT! We went to "The Greek Club" which is an ex-pat hang out in the ritzy part of town arriving at around 6:45. My housemates managed to snag a table, though the bar area was already quite crowded. We drank Tusker Kenyan beer in honor of Obama and waited for the inauguration which was at 8PM our time. It is luck we got there early, because Dr. Jacobson was turned away, apparently there was not room for any more land rovers in the parking lot. (Gated, as all lots are here) The bar had a giant tv and we got to watch all the proceedings on CNN, the crowd was excited and there was lots of cheering. It was a really nice way to celebrate the inauguration, and we probably wouldn't have gotten to watch it at home because we would have been at work.

Wednesday was my first hospice 'Day Care'. The concept of day care in western hospices is respite care for the patients care givers- there are usually volunteer drivers who pick the patients up once a week or once a month and bring them to the hospice center for nursing visits, meals, entertainment, and stuff like hair cuts and nail polishing during the day, giving the care givers at home a day off. Here, it has had to be adapted. The Selian hospice volunteers arrange for a location in the town- usually the church or the school and make lunch for everyone. The Selian team brings medicines and some small food gift and our Evangelist and for the most part the patients come on foot, although they do sometimes go out with the land rover to get people. We had introductions, a brief prayer service, lunch, and then Namayani the clinical officer (like a PA) and I saw between 20 and 30 patients from 30-70 with HIV/AIDS - we look at their blue cards which is the official record of their antiretroviral treatment and CD4 counts, ask if they are having any bothersome symptoms and get a brief related history to those symptoms, and then prescribe any medications we think they might need. We did all of this in 2.5-3 hrs. Meanwhile, part of the team and the visitors from STEMM went out and visited a patient who could not come in and one who was in the hospital, both of whom ended up dying Wednesday evening or Thursday morning. It is clearly functionally very different from the western hospice concept of day care but it seems to provide a valuable service for the patients - a quick, free visit to the doctor for minor complaints (we did tell those with issues too complicated for us to manage in 10-15 min or without further diagnostic testing to go to the clinic or hospital) and some nutritional flour and fruit. And it is more efficient for the team than going to each patients home, so they can serve more patients this way. They are not constrained by the Medicaid definition of hospice, so they provide palliative care services to anyone with HIV/AIDS or cancer. (and probably a small hand full of other illnesses)

Wednesday night we had an Obama party for the interns. We made pizza, which was a big hit, passion fruit juice, and Dan and Ann got some cheese and crackers and chips. And of course we had beer, but the interns seem to drink mostly Fanta and Coke. Very unlike American interns. :) We toasted the election and had some good conversation and food.

Yesterday (Thursday) was an administrative day for the palliative care team here so I rode into town with Joel, Dan, and Ann and we confirmed our safari plans. We are going on a 3 day, 2 night safari visiting Tarangiere national park, Lake Manyara national park, and the Ngorongoro crater for a game drive. We will be staying in tents, but hopefully the lions won't be walking past at night. (We've heard some stories about this.) I finally got my walking tour of town and so now I know where to go for the internet cafes and the best Samosas, and we started looking into Tanzanite, but it's fairly expensive even here so I doubt I'll end up buying any.

Today - daycare again, then preparations for our safari! I'll find a fast internet connection Tuesday or Wednesday for some pictures.