Flying Medical Squad

I am home in Arusha alive and barf free from the flying medical squad. It was absolutely amazing. I met the team Monday at 7:45 at the airport and we loaded the plane with suitcases of medications and equipment and then we set out around 8:30. It was me, the pilot Jack - a polish guy who's lived here for 7 years now, and Trudy, a Swiss woman who is the secretary for a medical flight company there and is going to help organize the office here at some point. I got to ride in the co-pilot's seat for the first day, wearing the headset and hearing the air traffic controllers, etc. (But of course I didn't touch anything.) The plane seats 6, or 4 comfortably, with a small cargo area in the back and a small cargo area underneath. We flew about 25 minutes south to Emberet where we dropped off our overnight bags at a catholic mission and picked up the clinical officer that goes out with the team. We were flying at 5000-6000 feet which actually seems really close to the ground and you can still see a lot of detail. The runways are just mowed strips of dirt and grass. We had to fly over the runway once before landing to make sure that there weren't any major holes or animals in the way, and the tight turn going back around was always the hardest part of the flights for me from a nausea perspective. We did clinics in 3 tiny villages on Monday, flying between them - they were all within 25 minutes flight or less.

My job was pregnancy checks - I checked the blood pressure, looked at the eyelids for signs of anemia, checked for edema, and then measured the uterus for an estimation of age and identified the position of the baby if they were over 30 weeks. I then attempted to ask them if the baby moves and if I couldn't get that answered, I would just do a quick ultrasound for the heartbeat. The first day, I ultrasounded almost everyone but on Tuesday and Wednesday I was doing better with the phrase "Baby moves" in swahili and massai. I did between 5 and 20 ladies at each spot, except at the places were there was no bed or cot, in which case i just did the blood pressure, anemia check, and edema check. I found one baby at 36 weeks that was breach, and I asked the clinical officer what we should do, thinking at least we should warn her that it might be a rough labor etc, or that maybe she'd be advised to try to get to the hospital to deliver. His response was "Sometimes they turn around." so we did nothing, other than note on the pregnancy cards they all carry to follow the progress that it was breach. So I'm not sure what the point of checking is, but oh well. I wish I was able to take a picture of my 'office' in some of the towns - only one had an actual bed, the other were cots made of wood and twigs that were in various stages of coming un-made, or once 2 church benches side by side. Unfortunately, the Massai don't like having their pictures taken (and who can blame them - I'd be pissed if some foreigner came into the clinic while I was seeing my doctor and started taking photos) - so all the photos from this trip will be landscapes or from the air, no people. I generally try to avoid pregnant ladies at all costs, but the pregnancy checks weren't that bad and with no privacy or gloves, and no way to do anything with the results, I was in no danger of having to do a bajanginal exam.

Once I was done with all the pregnant ladies, I helped Jack and Trudy with immunizations or I helped the clinical officer, Moshi, with counting medications. Like in hospice, medications are dispensed from a large plastic bottle of pills into a small (1.5x3 inch) zip lock bag. The bottles of pills are kept in 2 rickety old hard backed suitcases, there is a third for liquid antibiotics for the children. Almost everyone gets an antibiotic if they have bothered to come see the clinical officer with a complaint - the favorites were Cotrim (bactrim) and doxycycline, though penicillin V and erythromyacin also did well and cloxacillin was popular with the children. The often also get 12 paracetamol (Tylenol) or 18 ibuprofen. The kids are all brought with their vaccination / growth charts - the mamas keep these - and weighed and then given any vaccines they are due for. We saw a lot of newborns - 6 months who were getting DPT and oral polio, but some measles and mumps were given and the pregnant mamas get at least 4 tetanus. Kids still die of tetanus here - Jack told us about a kid he flew to a hospital with tetanus - they had started vaccinating the previous year in that village but the mama didn't think he needed it. He died a couple days later in the hospital at Haidam. Frustrating.

So we did 3 clinics Monday, with a break between the second and third when we set up the folding table in the shade of the airplane wing and ate a lunch of bread and marmalade and coke. At the end of the day we returned to Emboret where we had a excellent dinner of rice and beans and greens and a beer and Jack played the guitar after dinner and we sang together. Tuesday, we set out at 8:30 and again did 3 clinics, the last in a brief thunderstorm - there was no bed here so I was helping Jack vaccinate babies and mamas under the wing of the plane while it was raining. Trudy got to sit in front Tuesday so the airsickness was worse, but I did manage not to barf. Tuesday night after dinner - rice and cooked greens from India (one of the priests brought some seeds and grows his favorite greens) and an eggplant dish and fries - we played Uno. Jose, the priest from Brazil, was terrible - he loved making up rules to give other people extra cards. Not priestly at all, but fun. Today we had one clinic, which was actually in a nice church at a town where people were less pushy (most of the time, they were crowding as close as possible to be next, which is fairly claustrophobic and pretty hazardous from a needle safety perspective while vaccinating. Then we flew back to Emboret and had lunch at about 12:30, and then home to Arusha. Lunch was Ugali - a corn meal dish kind of like pollenta but unflavored - at Trudy and my request - I hadn't gotten around to trying it yet. Most muzungus think it is terrible, but I actually enjoyed it quite a bit - it may be totally flavorless but it has a nice texture and consistency and you eat it with curry or sauce.

I am really glad I got to go out with the flying medical squad. Aside from the landings, the flying was actually surprisingly pleasant and fun for someone with fairly severe motion sickness, and I feel like we actually helped a lot of people (at least with the vaccinations) and I got to see some beautiful places. So often it feels like we're not really doing much for our patients here - maybe making them feel better in that they have received care but rarely fixing big problems in the hospital. (To be fair, many of them are problems that just can't be fixed given the resources they have here) It was nice to do something that is tangibly useful like vaccinating - even if you don't need to be a doctor (or even a nurse) to do it, you can do it and it will prevent childhood deaths.

To clarify for anyone reading the blog that doesn't know me well - the Marmalade listed at number one on my things I miss list is my cat, Marmalade, not the jam product made of oranges. :)