Winding down

As my time here in Africa comes to a close I've been trying to get some things done that I've been intending to do but hadn't gotten around too. (I blame African Time). This week I completed my review of oral morphine prescribing by the hospice team. The number of patients receiving repeat prescriptions during 2008 could be counted on 2 hands, and even the repeat scripts were not frequent enough to achieve adequate ongoing pain control, at least by American standards. And of course we still don't have any morphine - when I got here in January I was told we should be getting some soon, but that doesn't seem to have materialized. I will leave the data I copied (by hand) for Dr. Hartwig and perhaps he can get something more useful or encouraging out of it. I am scheduled to give a talk on pain and symptom management to the doctors and nurses at Selian next Thursday. I am having a pizza party for the hospice team on Thursday evening. And of course there's the Flying Medical squad Monday-Wednesday.

I spent this morning doing some final shopping and ordering the last of 3 outfits I am having made - the first, a skirt and shirt made by Mama Makule's tailor (who also made my traditional Tanzanian dress) turned out wonderfully, so I am having a dress made there. There is a tailor in town who caters to Muzungu (foreigners) though, and she also runs a non-profit home for developmentally disabled children, so this morning I went to order a dress from her as well. It will be 10 dollars more than the other tailor, bringing the total cost to 25 dollars, but it benefits a good cause. Plus, it's still amazing to have something custom made for 25 dollars (plus the 6 dollars I spent on the fabric - but that includes lining, zipper, all other notions, and the sewing itself.) After the market, where I bought the fabric, and the tailor, I hit Shop Rite for some milk and the coffee store for some coffee beans to bring home. I'm fairly certain it's not illegal to import coffee because it's roasted. Then I headed back up hill (Shop Rite is at the bottom corner of the town) and across town past the little grocer that sells tomato sauce cheaper - 1.50 for a large can vs 1.30 at shop rite for a tiny one. I made it to the Meat King just before they closed at 1 and was able to get the mozzarella and chicken for the pizza party. We won't put pork on the pizzas because almost none of the locals eat it. Laden with my purchases, and now on the opposite side of town (but at least not as far down hill) I headed home. At the foot of Il Buro road (the road we live on - it's about a 15 minute walk from the base to our house) I twisted my ankle. The locals seemed genuinely concerned, and surprisingly none of the taxi drivers that park there tried to take advantage of the opportunity to get an extra fare. I managed to hobble to one of the many pharmacies on the way home and buy and ace wrap and Bryant and Eric kindly came down the hill to meet me and help me home. I'm fairly certain nothings broken, but it's definitely sprained which is going to be a pain in the ass. Today I am icing and elevating and I'm considering skipping church tomorrow for more of the same, particularly since I am committed to working Monday through Wednesday.

Which brings me to the flying medical squad. Apparently, the flying medical squad does mostly well baby checks, vaccinations, and pre-natal care. None of which I am specifically trained for, and all of which I have decided not to do as a practicing doctor in America. We will fly out Monday morning to somewhere in the bush (they told me the name but i forgot to write it down so I've forgotten it.) We'll spend all day with the patients - I will probably be in charge of blood pressure checks and fundal heights, while the pilot (who is not medically trained) will take care of vaccinations. We'll spend the night in a mission settlement nearby and repeat the clinic Tuesday and Wednesday. Eric is kindly allowing me to borrow his tape measure and obstetric emergencies cheat sheets, though it's unlike we'll have any of the drugs or equipment we'd need in an obstetric emergency. Apparently, when they don't have any volunteers to go along, the pilots do everything. The pilots get their medical training from a catholic priest who also has no formal medical training. So I'm trying not to feel woefully unprepared for the patient care I'll be doing, but not entirely succeeding. At least Jane gave me some anti-nausea medications - she went on one flying medical squad flight and barfed the entire time. So I have lots of exciting things to keep me busy till it's time to come home, and while my time is winding down, my list of stuff to do seems to be ramping up. :)