Palliative Care in Tanzania

I walked up the road from our house - my first time out on my own - to the Il Buro Safari Lodge, where we heard there was some internet. For 3,000 shillings (2 dollars) I have a half hour. Unfortunately, The computer sounds like it is a jet engine about to take off when loading websites and the zip drives appear to be broken so no pictures today. Il Buro is the name of our neighborhood. Some other time I'll take a picture of the Il Buro shopping center, which is across the street from our house.

I met with Dr. Hartwig yesterday. He is the director of the ELCT's (Evangelical Lutheran Church Of Tanzania) hospice / palliative care coordination program. He is trying to establish palliative care here in TZ, primarily for AIDS patients but also for a growing lung cancer population. He has been here since 2005, I believe. He and his team of another, Tanzanian doctor, a nurse, and an accountant coordinate a network of about 14 hospitals with palliative care programs in various stages of development. They all have at least one dedicated staff (a nurse) and a team of volunteers from their catchment area, almost all have cars now and Dr. Hartwig's organization supplies them with medications and resources, as well as having training sessions and site visits regularly. It seems this is a really great foundation and it is rare for palliative care to be provided by a network of hospitals - most hospice / palliative care programs are free standing. They get support from the ELCA (American Lutherans) the APCA (African Palliative Care Association) , the US fund for faith based HIV/AIDS relief work, and several hospices in Colorado. The major hiccup in all of this is that they have no narcotic pain medications at most of these sites. There are only 4 sites in the country that have government clearance to get and use oral morphine - 2 in the capitol Dar es Salam and one in southern Tanzania and Selian here in Arusha. The one site in the country that makes this medication, however, is out of the preservative needed for the liquid formulation (which is the only legal formulation.) So even Selian's hospice team has been out of oral morphine for a few weeks. But the other 13 or so sites in the palliative care network have only NSAIDS (mainly diclofenac which isn't used much in the US) Tylenol, Amitryptlyene and Tramadol for pain management. Once in a while they'll get some codeine tabs. (Somehow that is legal but all other opioids are not) Since the main principle of palliative care is effective pain management, for many of their patients, they cannot provide true palliative care services. Still, it seems like they are establishing a network of well trained, caring people and they are working on applications for the other sites to get morphine (though how they will more than quadruple their supply, since there is only one supplier, is another question.) In a country where more than 90% of all cancer diagnoses lead to death (there is only one center that does chemo/rads, in the capitol) and where the death rate from HIV/AIDS continues to climb, effective palliative care supplied to as wide an area of population as possible does seem critical.

Yesterday afternoon was quiet for me - I took a nap - I'm not over my jet lag / chronic sleep deprivation - and then Joel made us chicken with veggies and rice for dinner. I tried Castle Dark African lager, which I quite enjoyed, and read some of The White Nile and went to bed early. This morning we attended the non-denominational ex-pat christian church here in Arusha and then went to Shop Rite. The church service was nice, with lots of songs (I was prepared to be annoyed by all the new age hymns, but then we sang Here I Am Lord, so I really can't complain.) Shop Rite is a large grocery/dry goods store, basically like a grocery store at home (maybe like Aldi - limited selection). Pretty home-like though, they even had my favorite Irish cheese. Now we have a lot of eggs and some pizza making supplies for our party Wednesday to celebrate Obama's inauguration. Yes, people are excited about Obama here - there are copies of his red and blue face logo everywhere - dala-dalas (minibuses), roadside stands, personal cars, etc. Maybe we'll even be able to borrow a laptop from someone and watch his speech on you tube.

Tonight I must prepare for my first day with the Selian palliative care team and figure out some sort of carrying system for my white coat that prevents it from getting wringled or dusty. It did not fare well in the land rover on Friday.