The Cook of My Food

Alphan died November 23rd. He was 27 years old. On December 13th his son was born.In a lot of ways this story is typical for sub-Saharan Africa. Tragic ways, distressing ways...
Alphan was my friend. Yes I paid him to cook food that he bought for me in the markets of Mwanza. In Swahili you do not have a cook but you pay someone to be the cook of your food.
I discovered that Alphan died because someone sent a text to my Tanzanian cell phone that a physician colleague is using in Dar this month. In addition to the announcement of Alphan's death was another missed message. This one was from Alphan. It said' "Please call me." I knew he had been ill but when I last saw him a week before his death he was supposed to be improving.
Alphan cared. His work reflected his commitment to excellence. He was intellectually curious, reading my books, going to school in the evenings. He was funny and his smile came easily and was luminous. He was a good man.
I am so sad to lose him.

Important and Insignificant

A person who viewed himself as insignificant would not spend time away from his family and go to work in a developing country. Significance is a major motivator of this activity but does that make one who engages important?
A large humanitarian organization visited recently. Included in the delegation were two representatives from the United States House and the president of the organization. The stated goal was to encourage the development of global health champions within Congress. I was given a heads up that they would sit down with me for an hour or two to talk with me and other physicians on site. My sense of importance swelled. The next day I was told that the delegation would not have time to meet with me.
My elevated self-importance was transformed to lowly insignificance.
Paschal or Chesterton or both observed the dialectic of human existence that man was supremely important yet wholly insignificant. It seems that we in the developed world have a healthy sense of importance that actually magnifies when we leave our comfortable environment to spend some time in a developing country. Just how insignificant do the people here feel? Is it a factor in the apparent facile acceptance of death? No human can live unaware completely of their importance nor of their insignificance. We important people of the West however could use some reminders of our insignificance. Likewise the people of the Rest could use reminders of their importance. I believe the humanitarian organization got it mostly right and I am grateful for the reminder.

Be Sensitive and Make It Interesting

Can you blog with others in mind? It seems a mostly self-conscious act. But there are bits of patronizing opinion that might hurt others.These thoughts coupled with trying to keep it interesting(again with others in mind ie you the reader)has paralyzed my hunt and peck keyboarding for a few weeks.

I find life most rewarding when change is happening. Wouldn't everyone want a system to change that suffers from high child and maternal mortality? As an outsider in this setting, I cannot lead progressive change because it risks dependency and unsustainability. I am hoping change can be catalyzed. Because that is the role that I believe is most appropriate. Ideally the process won't require the continuous presence of the catalyst to perpetuate. This I don't know...

Most exciting for me is the recent decision by the director of the hospital to move the casualty department into the department of surgery. He has created an Accident and Emergency Committee chaired by an orthopedic surgeon(mentioned in a previous post)to lead the transformation of casualty to an A& E department. So Presbyterian of me to get all excited about a committee being formed.

Tropical diseases and abject poverty provide great fodder for interesting stories. What makes it interesting? Certainly a good storyteller helps. I don't have any stories today.

Ferris Wheel

The fair ride most used in analogies is the roller coaster. But I'm choosing the ferris wheel. Ups and downs without forward progress.... then ending back where you started, at the bottom...
Have you read many descriptions about the view from the bottom of a ferris wheel? That's where my ride was last week so the view looked something like this....
She must have been about 3 or 4 and she lay whimpering on the stretcher beside a mother sitting with her infant in her arms. Blisters from second degree burns covered her buttocks and legs. She shared a lollypop with some flies. Alone, she would briefly doze then wake up crying. Her crying stopped when I rubbed her back.
Systems change, capacity building are part of the view from the top of the ferris wheel with Trauma Registry, pediatric resuscitation trolley, triage system, bedside ultrasound, emergency nurse training, Primary Trauma Care Course all in the works. Setbacks, delays and barriers frustratingly abound. Nothing has changed.
You always get off the ferris wheel at the bottom, don't you?

Per chance

He was sitting outside the casualty ward office. We exchanged some polite swahili greetings. He asked in English if I was a Father, not the first time I'd been asked the same question. "Not in the way you ask, " I replied.
So we talked for a little while. He was there to get steroids injected into overactive scar tissue on his chest wall suffered in an unspecified injury. He said the injections were helping.
He is in Mwanza on scholarship to university studying sociology. This education is to help him in his work in the community with refugees from Burundi, Rwanda and the DRC.
Turns out I reminded him of an Englishman who worked an office near his home village. When I shared that I was actually from the U.S, he said he'd visited Orlando.
He said how real some of the creations in Disneyworld seemed. This after inviting me to the park near his village where work is conducted with chimpanzees.
He was in Orlando to attend some kind of global conference of young people that do refugee work. His intention is to work for Peace.
Today he gave me some hope.

Why

A small roach scampered from beneath the laryngoscope blade as I lifted it from the box to place on its handle. It was symbolic of the futility of my efforts to follow.
A 6month old baby had stopped breathing. This following a 5 day illness during which he was treated at a dispensary and brought today to our hospital weakened from his struggle.
Why did this baby die?
Was it because his Mother was poor?
Was it because he was born in one place, not another?
Was something misdiagnosed or inadequately treated early in his illness?
Was it because he had an overwhelming pneumonia with poor defenses to disease?
Was it because I couldn't get a tube in his trachea?
We talk about the burden of disease. What about the burden of sadness?

Big Splash

Growing up my brothers and I would compete to see who could make the biggest splash jumping into the pool. I never won.
As mentioned in my last posting, I succeeded in getting nothing accomplished in my first three months in Mwanza. Making a difference, making a measurable difference...is that what it is all about? A big splash makes a difference but once the ripples die away, the pool, perhaps short a small volume of water remains the same.
This visit I brought two vital sign monitors purchased with the generous donation of funds from my home church, Davidson College Presbyterian Church. We've put the monitors to immediate use at the triage station and in the wards of the casualty department.
Today another woman with white eyelids and abdominal pain was rolled in on a stretcher. The new monitor revealed her blood pressure to be 85/49 and her heart rate was 140. She was cool to the touch and her abdomen was tender. In a previous posting I shared a similar case that turned out to be an ectopic pregnancy. Today was a virtually identical experience as I squeezed in the only unit of O positive blood in the hospital and waited for her to get to theatre. After she was gone I walked around the ward with a nurse from Kenya on her first day in casualty and we used the new monitor to take the women patient's vital signs.
A woman who moaned quietly as the drama of the first patient unfolded shared with the nurse that she might be pregnant. The machine reported her blood pressure as 105/79 and her heart rate was 107.
She got up to provide a urine sample ordered by the gynecology intern and passed out.
We repeated the same interventions for this quiet woman who also had an ectopic pregnancy.
These new monitors will accomplish nothing that could not have been accomplished without them. Nurses taking vital signs and a history on the patient's arrival is a process that requires no more than mercury manometers which are present but in short supply.
The question whose answer disturbs me is: When these monitors no longer work and the big splash(ok, small splash) and ripples have subsided, will the pool short of a small amount of water remain the same?