Backing up to last week for a bit... on my birthday, I also received two new housemates -- a very famous Duke ID attending and his wife. Yeah, I know what you're thinking, so I'll just put it out there -- it definitely is weird to be in my PJs and glasses making tea every morning in front of an attending-level physician!! But, I will say that both of them have been absolutely awesome and super fun :) The attending helped establish the Duke-KCMC collaboration, so he was on a whirlwind mission of seeing all of his old friends -- which meant I met new people!! (Ok, they are old(er), so not exactly people to hang out with, but I can't be picky in Moshi!!) And they used to live in A5 for 4 years, so they totally gave me the skinny on Moshi, and took me to my first hash!
What's a hash? I hope you have that question, because I sure did, and everyone was like, Umm, do you even speak English? A hash is hiking trail that someone sets, with an "X" marked on the ground, indicating there is a treasure buried there!! Just kidding, actually it indicates that there are 2-3 possibilities of where the trail could go and you just look around until you find the next flour mark indicating the proper direction. It's really a lot of fun -- you can run or walk the hashes, most of which go through the backwaters of Moshi. My first hash, the day after my failed Kili hike, was actually on the slopes of Kili -- so I got a hike in on Kili after all on my birthday weekend. And it was tough!! ... because we took the runners path though we were walking, AND because the guy who set it holds the record for the fastest ascent and descent of Kili. All 20,000 feet in 8 hours!!! yes, CRAZY. Oh, and his day job is making some of the best coffee in the Kili region...
Some pictures from both hashes I've been on...
see?? proof we were on Kili!!
cute children on the slopes of Kili
see?? proof we were on Kili!!
cute children on the slopes of Kili
seriously walking through people's yards
many rock paths through rivers... one day we'll be in the river, I'm sure
I can tell, bridges are going to be a huge theme this year... 
Coffee plants and banana trees, the lifeblood of Kili agriculture
Little kids play hopscotch here too!!!!!
the sun setting over Mt. Meru... end of hash #1
On a more sobering note, the most salient memory from last week was watching two patients die during rounds. Literally. The first lady (23 wks pregnant with twins) died due to respiratory distress as a result of presumed PCP pneumonia (an infection that only HIV positive people get). It's presumed because there are no diagnostics here -- so many diagnoses are presumptive, which really makes me wonder... do we do too many tests in the US to diagnose or do we diagnose wrongly out here too often? Of course, on the whole, I believe the latter, but on the margin, maybe we could use our resources more wisely in the States....
the sun setting over Mt. Meru... end of hash #1Anyway, we walk into the next room over to find another patient, this time 26 weeks pregnant, unconscious/not breathing, with an unclear diagnosis -- meningitis, subarachnoid hemorrhage? So we started resuscitating her, although really she looked like a rag doll -- totally floppy, eyes open and lolling around... we finally got her intubated by anesthesia about 35 minutes after ventilating her... at which point someone comes in frantically asking, 'Where's the epi?' (That's epinephrine, usually a drug of last resort that tells you someone is really sick.) At that point the first lady had coded, meaning she wasn't breathing and her heart wasn't beating, so then we started CPR/chest compressions on her, but of course she was already gone. Meanwhile, the other lady had gotten transferred to the ICU, but she was brain dead and extubated 12 hours later.
It was horrible. I have never seen a scene like that, and compressed into 60 minutes on top of it all. I was pretty much sleepwalking through the rest of the day, trying to get those pictures out of my mind and at the same time, trying to remember every detail so that next time, maybe I could be more helpful, maybe we could save someone -- even one out of five might have been a good outcome -- but here, none of them would have had a better fate alive given how sick they were.
Everyone has stories like these when they do work in low-resource settings. Even two weeks ago, this patient whose emergency c-section I watched died about 4 days later, on my birthday, of completely unclear causes. Everyone can tell these stories. The thing that is great about research is that we understand so much about the obstacles, the diseases, alternative treatments, etc, and ultimately we can make the situation better, but I also realized that it doesn't change the outcomes of these single patients day-to-day. So again, I am thankful that Jeff is so clinically-oriented -- although many researchers would disagree, to me, there is no point studying all the problems and waiting for the results of your work to get published to make a difference, when the patient down the hall could survive if you did something about it. And he does, every day. So although I don't have such clinical skills yet, I still hope to make a difference for our patients -- and I'm determined for my blood drive to become a recurring event in Moshi.
Hash #2 pictures....
the people who set the hash had bunnies!! (but they eat them :( )
you can't quite tell, but we caught some boys bathing... they are hurriedly clothing in this picture :)
Hash #2 pictures....
the people who set the hash had bunnies!! (but they eat them :( )
you can't quite tell, but we caught some boys bathing... they are hurriedly clothing in this picture :)
cool tree we saw!
Typical construction around here... really sturdy!
1+1=11. Explains so much about Tanzanians' math skills
Typical construction around here... really sturdy!
1+1=11. Explains so much about Tanzanians' math skills
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