May 27, 2015,
Wednesday
Hello Everyone!
Greetings from Tanzania! I am
Kathy Dunford and I used to be a Maryknoll Lay Missioner and a Physician
Assistant in the USA and was sent to Kitale, Kenya, in 2008 to work in
healthcare there. After finishing a
rewarding five year mission there and thinking I wanted to retire, I relocated
from New Jersey to the coast of Southeastern North Carolina. But alas, God had other plans for me and now
I’m back in mission part time working with Tom Scott and Father Jim Conard out
of Kowak Hospital in Kowak, TZ. I am a
volunteer and am helping mostly with in and out patients for about 3 weeks now. I’m hoping to spend six months here and then
go back to the States and perhaps if this works out, come back each year until
I really retire. Prior to Maryknoll Lay
Missioners, I worked as a PA in New York and New Jersey for over 20 years. I graduated from Cornell University Medical
College in New York City back in the 70’s when the PA field was brand new and
so was I!
Routine of hospital work here starts with morning report
given by the night nurse - admissions overnight,
details of admissions – history and physical, lab results, etc. Totals of in patients by ward – maternity,
post op surgical ward, male and female wards, and pediatric ward.
We start our day with a prayer
for guidance from God, a short reading of the Gospel and then a “sermon” by a
member of staff. This is a part of the
day that is so gratifying in that we all know we will do our best by the
patients, but the ultimate healer is God through his son Jesus Christ. Then we gather for morning report. After that, the doctors make morning rounds
on all the in patients, assessing their progress, ordering test and medications
as necessary or discharging those patients who are medically stable.
One in patient was a 9 month old
child who we think has sickle cell anemia since he had a transfusion 36 hours
ago, but now the lab value shows virtually no change in his blood count. Sickle cell is fairly prevalent here in
Africa and it can easily be misdiagnosed and consequently mismanaged and the
child’s underlying condition is never diagnosed and returns to the hospital 3
or 6 months later much sicker. Fortunately,
we have a good reliable lab here to help us diagnose the patients. This child did have severe malaria which can
cause the blood count to drop a lot, but once treated, the blood count should
go up, but this child’s did not.
Then it’s onto Out Patient
Department after seeing all the in patients.
One elderly gentleman had been to the capital of TZ, Dar es Salaam for a
long time in the last year, and was diagnosed with long standing hypertension
and diabetes (Type 2), but he now wants to see a doctor because he has
headaches and vision problems, all symptoms of recurring, untreated
hypertension. It turns out that his DM
is ok, but he ran out of his medication yesterday, doesn’t know the name of the
drug(s) he was taking and had been on hypertensive meds, but not currently and
doesn’t know the name(s) of the drugs he was on. This is an all too common scenario here in
Africa. But we were able to treat him
for his chronic conditions and put him on the right path for recovery. His son asked why we are giving him medicine
for his hypertension and we had to do some health education about strokes,
etc. Follow-up will be in five days.
Another case was a 2.5 year old
child who had a history of blood transfusions over the past year or so, and now
he was very pale, and listless. Further
questioning elicited a social history of 9 children born to his mother, with 3
of them dying under 2 years old. So, a
sickle cell test was ordered as well as blood tranfusions. Again Sickle Cell is quite common here, but
can easily be overlooked in the face of several anemias secondary to malaria
which was the case with this child.
Towards the end the day, one of
our assistant doctors, Dr. Paul,
performed a few circumcisions and
I was very impressed by his surgical skills.
He recently was trained to do circumcisions sponsored by a US/Tanzanian Government
program, along with one of our RNs nurse who was his assistant in the
procedure. The custom here is to have
the puberty aged boys undergo circumcision with their respective tribe, but now
with the HIV rate in TZ at over 17% (the US rate is less than 1%, to give you
an idea of how prevalent HIV is here) and it is proven that circumcision is an
excellent way to control the spread of HIV.
In the area where Kowak is, there is specific tribe that does not do
circumcisions, but now the push is on in the last few years to do them and
reason why is part of the education of the people, despite circumcision going
against the normal tribal customs. The
Government here and at our hospital are doing everything they can to prevent
HIV, but as you can image, it’s an upward fight. It’s always the way: the poor suffer the most and as Pope Francis
would say, we must be merciful to those afflicted, not judgmental or cause
further stigma to those affected. We do
what we can, one patient at a time, relying on God to guide us. That’s it for today. God bless you all and God bless the American
taxpayer for all their help given freely to the Africa people.
May 28, 2015 – Thursday
Helped the Chief Clinical
Officer, Dr. Paul, with rounds today in the maternity and post surgical
wards. Here in Tanzania a majority of
the surgical wards are filled with women who need gynecological surgery. Unfortunately, women neglect their health
for most of their reproductive years, hence the need for surgical intervention
at relatively early ages – 40’s and certainly from 50 years and onward. Our Medical Officer, Dr. Ernesti, has many,
many years of experience at surgery and we are fortunate to have him with us
because the ladies here need a good surgeon and also the mothers who run in
trouble with different obstetric problems.
Where it would be routine in the USA to do a C Section on a woman with
just one risk factor, such as cephalic pelvic disproportion, here the woman go
into labour and wait at home until their lives and the lives of the child are
threatened. Then they realize that
there is a doctor here who can help them and saves lives! Dr. Ernesti is a fully trained surgeon with
many years of experience. He also has a
wonderful personality and has many African stories to tell us and the
patients; so he is a delight to work
with and the staff and patients love him.
And when I watched him during an operation, he and the OR staff say a
prayer before the operation for God to guide their hands to help the
patient. Very moving and is unheard of
in the USA!
Early this morning a young boy
came in with his father after a road accident and the young child was comatose
from an internal head injury. To find
out the extent of the injury with a head CT is impossible here (there are no
scans around here except specialty hospital about 4 hours away), so we rely on
clinical findings to help the child. We
are hoping he will wake up soon as his family watches vigil over him. With an internal head injury like this boy
assumingly has, it is a watch and wait game we play and we pray for his
recovery. Kids are usually resilient,
so we are hoping for the best.
May 29, 2015 – Friday
TGIF Friday here in
Tanzania. Spent the morning helping in
the HIV Clinic and we saw about 40 or more patients today. Several of them were newly diagnosed. No children today fortunately. Sister Reetha who runs the clinic is a
Clinical Officer like I was in Kenya and does a wonderful job of taking care of
her patients. She is very meticulous
about the clinical side of disease, social side, and the recordkeeping, which
in this day and age of strict donor accountability is invaluable to keep the
medicines, paperwork, staff, computers up to date and in stock. A donor will not nowadays give out money
until they get statistics and reports on how their money is being used and
accounted for, so Sr. Reetha is doing her job “kabisa” (greatly!).
I may have the afternoon free,
but will go to the Out Patient Department to see if there are any patients
there to be seen. God bless you all for
donating and helping Kowak Hospital.
“Tunashakuru.” We are grateful.
SECOND WEEK AT KOWAK HOSPITAL, TANZANIA
June 1, 2015 – Monday
The week started out with a 4 year old boy admitted last night for a supposed
fractured leg 2 weeks ago. It was
treated by a local “medicine man,” but the splinting of the leg with wooden
sticks was done so tightly that the boy developed a wound, a very high
temperature, was breathing rapidly and was very ill looking. I thought he had bacteremia with all the
symptoms which had progressed from his original injury in the leg, went to his
lungs, causing pneumonia and now he had a stiff neck so the presumptive
additional diagnosis was bacterial meningitis.
And to add insult to injury, the x-ray showed he never fractured his
leg! This poor kid was a victim of poor
treatment by the local “medicine man,”
but I hope he does not have to pay the price with his life. This points out that Kowak Hospital seems to
be the “option for the last resort” with some of the local people and they come
to us with what could have been something relatively simple thing to treat and
these are the consequences. We will do
everything we can to save his life – as I’ve said, kids spring back fast with
the right treatment, and let’s pray for a successful outcome.
I spent several hours seeing patients in the OPD. In this region as elsewhere in sub-Sahara
Africa, malaria is at the top of the “top ten” diseases treated; so we treated
many of them today – it hits all ages and takes various forms of symptomatology,
but when a patient comes in complaining of a headache and fever, you need to do
a malaria test right away. Point in
fact, a mother and father brought in their 18 month old who was very, very hot
and convulsing. He had severe malaria
and it affects children (and occasionally adults) with seizures from the high
temperature. This child was also very
anemic and needed a blood transfusion right away. Malaria “eats” away at one’s blood count
when it is severe, hence the anemia. In
this child’s case, it was life threatening, as his body was starved for blood,
but the malaria parasites were feeding on his blood for their survival. But this child will do well once treatment is
instituted, as again, children spring back fast.
I have new found respect for some staff I’ve seen here and how they
quickly treated a mother in labour. The
child’s position was breech (head up, not down in the pelvis), and the mother
had been in labour at home for a long time.
The surgeon here, Dr. Ernesti, quickly examined the patient, an IV was
put into her arm, and she was rolled into the OR, all within less than 10
minutes! This was her tenth child! Is it too late to instruct her on the family
planning? That was joke . . .
June 2, 2015 - Tuesday
This is Tuesday so it must be CTC (HIV) day. Many patients were seen today, but I had to
interrupt and go into the “city” Musoma to see some people at the Diocese with
Tom Scott. We are hoping they will give
me a residence permit, and possibly a medical license to practice here since it
looks like I’m going to stay until early November when Tom leaves. Immigration here would frown on anyone
coming into the country and practicing medicine without their knowing about
it. The feedback from the Diocese was
very positive and we have to fill out forms and get documentation together for
another meeting next week.
June 3, 2015 – Wednesday
Did rounds with Dr. Ernesti today in two areas: post op surgery and maternity wards. Many women are taking advantage of our
services and the beds are full and over flowing into the next ward. A lady with a foot wound was admitted and
her sugars were very, very high – and the diagnosis was – you got it – severe
diabetes. Insulin was started and I
will keep seeing her daily until she gets better. We have seen quite a few diabetic patients
lately and I don’t know why it seems higher in this area than in other areas. Mostly women, hmmmm, why? Something I need to investigate.
June 4, 2015 – Thursday
The diabetic patient is doing better, but wants to go home now
(!). Her sugars are better but still
not normal but she needs wound care and overall education about her disease
before she can go home. Saw quite a few
patients in OPD, one of which was a 20 year old young, pregnant woman brought
in by her husband. Many women here
during pregnancy have complications and rarely go to the prenatal clinics until
they are in their 3rd trimester or even worse, until they are ready
to deliver. The Tanzanian Government
pays for first time mothers to have their babies in the hospital without charge
to avoid the high rate of infant mortality, and we at Kowak are happy to be part of the Government’s program. When you say “FREE” (“BURE”) here, no one is
shy about taking advantage . . .
June 6, 2015 – Friday
Another morning in CTC (HIV) Clinic learning more about the computer
program and registering patients correctly.
The computer program used is a complicated one, but necessary for the
data the Government needs to report the
statistics to the USA partners. One
partner is Baylor University in Houston, Texas. In this area, they are the overall
supervisor of the program and come here every few months to make sure we are
doing things correctly. The doctor who
comes in an American affiliated with Baylor.
I haven’t met her yet, but am looking forward to doing so. Sister Reetha, as I mentioned before, runs
the program at Kowak and she has taught many support staff to help with the
computer program, drug distribution, clinical assessment of patients, etc. We have a new Clinical Officer (CO) here,
Dr. Peter, and he is being taught the program. A CO is like a nurse practitioner
or PA in the US.
June 6, 2015 – Saturday
Had some extra energy today and decided to see what was going on around
the hospital. Did some rounding with
Dr. Ernesti and saw about 10 patients in OPD.
Dr. Ernesti also operated on a
middle age woman who had a “torsion” of one of her ovaries and also the other
ovary was cystic. He removed both
ovaries and sewed her up again and I looked in on her in the post op ward, and
aside from some pain, she is doing well.
One of the wonderful things here in Africa is the way the family members
gather around the patient and are so solicitous, loving and caring. They bring food, drink – all sorts of things
from home to help the patient and their great love and concern. Of course the hospital has no facilities for
providing food for patients and it was be too expensive anyway.
Dr. Ernesti told me about another patient he admitted in the afternoon
who had a bad case of – you guessed it – diabetes. I haven’t seen the details, but here again,
it’s a woman and severe diabetes.
Again, have to investigate why this area has so many female diabetic
patients. Genetic factors predisposing
them to DB?
Week of June 8 to June 14, 2015
My days are getting busier as I really get into things here at the
hospital, so I’ve decided to switch to a weekly blog.
What’s going on here? A one
year old boy was admitted with severe malnutrition. He was brought in by his mother and father
and he is their fifth child.
Malnutrition for children under two years takes its form not in
starvation, but in protein deficiency.
We call it PEM – Protein Energy Malnutrition which comes in two
forms: Kwashikor or Marasmus. This child had Kwashikor. In Kenya there were wards full of kids with
both types and it is a typical condition found in all parts of Africa and the
underdeveloped nations. The standards
here are to breast feed the baby for the first six months exclusively, then
from 6 to 12 months, continue breast feeding and add porridge and other soft
foods, like bananas, etc. Most mothers
will breast feed up to two years.
According the parents, the mother had mastitis in one breast around six
months and when the other remaining breast failed to give enough milk for the
child, they brought the child to a traditional healer, and then the child
really went downhill. At 12 months old,
he only weighed a little over 3 lbs.
So, we are supplementing the child’s breast feeding with energy
enriched porridge and hoping for the best.
He is clinically a bit better, but it takes a long time or the child to
gain the weight lost. It’s something
that can’t be done too quickly or the cardiovascular system can’t take the
additional metabolic strain, so we go slowly (pole, pole). In the meantime, the child seems a bit
better and more content to sleep instead of crying all the time - more like whimpering like an injured puppy.
(Update: this child died June 14 evening because the nurses were not able to
get an IV in him and they never told anyone for 3 days).
On the brighter side, a young 31 year old married woman was admitted
early in the morning this week with abdominal paid. Someone made the presumptive diagnosis of
UTI and anemia. A more thorough history
revealed she was pregnant about 12 weeks and had had this pain for almost a
week. She was groaning with pain when
seen and obviously very sick. She was
not bleeding but was very, very pale. I
was suspicious of an ectopic pregnancy and/or appendicitis in pregnancy, and
quickly got our surgeon, Dr. Ernesti, to see her. On examination, her belly felt like fluid,
more like blood, the doctor said. We
rushed her to the OR and she did have an ectopic pregnancy, but a very unusual
kind called a Cornual Ectopic whereby the fetus implants itself on the top or
within the wall of the uterus at the top and somehow grows from there. The uterus eventually ruptures, causing a
medical emergency to save the mother life.
And Dr. Ernesti certainly did!
Rushing her to the OR, she went into convulsions, but she was able to
maintain her blood pressure – barely – through the operation and survived and
is now doing well in the post op ward.
After the operation, Dr. Ernesti asked to see the father and brought him
in a kidney basin, the ruptured uterus and cut into the organ and brought out
the fetus of 12 weeks for the father to see his child. The fetus’ heart was still beating a
little. He then did a wonderful thing: he got some water and in front of the
father, nurses, and me, baptized the baby “in the name of the father, son, and
the Holy Spirit, Amen.” I was so moved
by this ceremony and the doctor’s need to send this child back to His Maker,
that I, along with the others, was in tears.
Then he wrapped up the baby in a paper, and gave the baby to the father
for burial. Well, what can I say? There are no words for what I and others saw
that day. Not only did he save the
mother’s life – she has three other children, but baptized the unborn child with
its heart still beating.
A phenomenon we see here in this region, especially with children is
severe anemia. I never saw this
extensive type of anemia while I was working in Kenya. It turns out that one reason why is the main
staple of the diet is cassava, a root plant that is grown here almost exclusively. The soil here is very poor for growing maize
or wheat (like in Kenya) and the rice that can be grown is very expensive for
most people, so they resort to a combination of cassava, millet, and sorghum to
make “ugali” and porridge. It is surely
the poor man’s “ugali” but is all that they have here and consequently it
causes anemia and malnutrition in the folks around here, especially kids. Most people around here are totally unaware
of their own anemia and walk around with about 30% , or more, less hemoglobin rich blood than the average
African. So their systems become used to
it, but any illness can trigger a crisis in their blood count and they need to
be transfused one or two units of blood during their hospital stay. Of course a
transfusion is not so simple here since 17% of the popular is HIV positive.
Well, that’s all for now. Stay
healthy and “nashakuru” (I thank you) for your financial help and prayers for
the people living around Kowak. Next
week we are having two sets of visitors:
a group of 3 senior Maryknoll priests are passing through and will spend
the night on their way to Nairobi and another group of 3 Americans from the
Univ of Illinois are visiting the Diocese of Musoma want to come out and see
what we do here on Wednesday. Most of these priests have worked here 60 years
like Fr Conard, our pastor. Liz Mach will be escorting the 3 American visitors.
Liz is a Maryknoll Lay missioner and has been here 40 yrs, since she finished
nursing school in MN.
Tom Scott and I took a trip into the Diocesan offices this week to
process my “Residence Permit” and apply for a medical license – keep your
prayers coming that there are no snags with these. We learned recently that a
medical license will not be needed if I get a letter from the District Medical
Officer (DMO) authorizing me to practice for just a few months. What a
blessing. He will be visiting us in a few days. God bless you all!
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