Reflections on my experience thus far

Last Thursday marked 2 weeks here in Tanzania and 1/4 through my trip. I haven't written much about my clinical experiences here in part because it is hard to know what to say, and in part because I don't want to exploit the people I am meeting here for a good story. But they are a good story, and the longer I stay the more apparent it becomes. Yesterday, at church, I was chatting with Ashley, the Denverite who arrived on the same flight with me from Amsterdam and shared my ride into town from the airport. On the flight, she had told me she is working with a non-profit organization that helps women's groups here, particuarly the Massai girls school. (Women are valued somewhere between cows and goats in Massai culture, as far as I can tell.) Yesterday, another ex-pat was asking her how she got involved with the group (while she was still in college - she graduated last spring) and she said "I founded it." The ex-pat community here is composed of tens if not hundreds of people like this - people who have found some need here so motivating that they either pick up and move here, or come once a year, once every couple years, etc with resources and knowlege to help. It is really an inspiring group of people. I imagine it must be very hard for their children - who grow up here in this selfless, caring, relatively tight-knit community to go off to college in America (which most of them do) and realize that not everyone's family is like theirs.

The locals that I have gotten to know are no less impressive. I had the honor of having saturday dinner at the home of Elizabeth, the head nurse/administrator of the Selian palliative care team. Over the course of the afternoon, she told me about how she had been to conferences around africa to improve and broaden her skill set - and then has been a faciliatator at similar things locally and throughtout Africa as she became and expert in home care. She even left her family and studied in Leeds for a year. Her husband, an internist at the local hospital has studdied abroad as well, in Boston for an MPH and probably other places as well. He works at the government hospital during the day and then at a private dispensary (small clinic and pharmacy) at night and on the weekends. Both of them put so much time and effort into bettering themselves so that they could afford the best education possible in tanzania for their two children.

As far as medicine itself goes - it is harder and in many ways more rewarding. When I go out with the pal care team for daycare, they are now having me see patients independently - with the help of one or sometimes 2 interpreters. (Eg: english->swahili, swahili->Massai.) We have no labs or xray equipment available and most of the patients we see do not have resources to get into town to a hospital that would have these facilities. So my therapeutic decisions are entirely based on history and exam. History is hard with the language barrier, and culturally people here are much less time-sensitive, so it is often hard to get a good idea of how long something has been a problem or how it has been changing over time. Add to this the limited supply of drugs (we bring a suitcase full with us) and time (we usually see 15-30 patients in 2-3 hrs at these visits) and it is very challenging to feel like you are giving your patient the best possible care. But then again, if it weren't for the pal care team these patients wouldn't get to see a doctor at all, and usually I do feel fairly confident that I can offer them relief for one or more of their problems after a through history and focused exam. And I feel confident that every patient I see needs a doctor, wants to get better, and can benefit in some way from my time and knowledge. (My American patients often do not meet all 3 of these criteria.) It is certainly frustrating to see problems that would be easy fixes in America and we can do nothing about here - my patients with cardiac chest pain symptoms or valvular heart disease really have no options here - we have no cath lab or cardiac bypass capabilities - but it is also rewarding when we can help someone feel better, particularly given the limited array of tools we have. And I can see why people who come here once keep returning.