Another Day in the Life of a Medical Volunteer

Yesterday was Day 3 at the Health Clinic and I had the opportunity to sit down with Mama Tiaso and another doctor-in-training to learn about family planning.  Family planning in Tanzania is essentially a meeting between a couple and doctors as to determine the adequate spacing between births that occur in a family, in addition to the use of contraceptives, and other methods to enforce such plans.  Tanzanians typically utilize two methods in terms of planning; natural and artificial.  Natural family planning revolves upon prohibition of intercourse during the time at which a female is pregnant. This method roots itself in observing ostensible signals of ovulation such as basal body temperature.  Artificial family planning refers to a variety of contraception techniques such as birth control pills and Norplant implant. Mama Tiaso particularly taught me about a more common hormonal birth control method which is referred to as IUD (Intrauterine device); a miniscule copper object implanted into a woman’s uterus during an age at which they may reproduce. IUD diverts unwanted pregnancy.  Later that day I again observed the routine rounds performed by Dr. Wanjara and staff and also learned of laboratory techniques utilized to diagnose certain diseases.  Blood and urine are most commonly observed and scrutinized via microscope after being placed in a centrifuge, which of course separates the blood and plasma.  Their methodology, as effective as it may have been in the long run, was remarkably unsterile, as gloves were not used to handle such species as urine and blood. 

Day 3 at the Clinic

6.24.13

MAMBO!

Pictured above is an elephant with five legs; a photo I took this past weekend.  I’ve returned from my four-day Safari where I traveled through Lake Manyara National Park, Serengeti National Park, and the Ngorogoro Crater.  The experience was honestly one of the best of my life.  Although residing in the wilderness will never quite suit me as a lifelong lifestyle, I survived the three nights without much of a struggle.  On the last night I was near the top of the crater, about 2300 meters up.  The view was indescribably breathtaking.  At various points of the safari I witnessed zebras and warthogs on our campsites (yes I was literally living in the wild), was an arms length away from an elephant, and observed more animals than I have seen in my entire life.  Extremely remarkable was my visit to the Masai village in the Serengeti, where the tribe relocated 25 years back.  Their traditions are unique from that of any other African tribe (for example they do not believe in medicinal care, disregard education to an extent, and pierce knives through their ears at 10 years of age) and beautiful at the same time.   I took over 400 pictures in a mere 3 days, but it was totally worth it.  Where else are you going to see an elephant with 5 legs?  It’ll be nice to sleep in a real bed today though, and attend the Clinic again tomorrow!

Adios for now– more to come tomorrow so stay tuned.

BOMB! and other fun things…

6.20.13

Mambo!So, I’ve skipped a day.  Why, you may ask?  Well a bomb went off in the town of Arusha (before you freak out, I am NOT staying in town and am safe and sound, at quite a far distance from where the explosion occurred) due to political violence.  This weekend marks the “Big Election” in Arusha.  Although I’m safe, I feel as though me and my group of 12 could not have chosen a better weekend to embark on a 4 day, 3 night safari where we will be far from Arusha.  Regardless, work yesterday was canceled as the surrounding areas, despite being safe, were risky to enter, especially as a “muzunga” or white person.  I did go to work today though, and thank goodness I did.  I experienced some things that even medical students in their third years do not have the chance to witness.  As soon as I entered the hospital, I was rushed into the labor ward.  I came just in time to see a white, bloody head popping out of a woman’s vagina.  Oh, the miracle of birth.  I was the only volunteer at the hospital today who came to the room quickly enough to witness the mother’s delivery.  I helped suction the mucus out of the baby’s bronchi and in its mouth (standard procedure for any baby directly post-delivery).  I also pressed down onto the woman’s fundus and massaged that area of her genitals, as I learned that doing so stimulates the uterus to contract and helps in slowing any post-partum bleeding once the placenta has been removed.  A uterus that is not firm is indicative of the woman being at risk for hemorrhage.  After an exciting morning I returned to work with Edita, the head receptionist, where I alphabetized all patients who had been cared for by the Clinic.  I took note of how slow and inefficient their system of alphabetizing was- what could’ve taken me 5 minutes using Microsoft Excel took me 5 hours using pen and paper.  I’ll say it again, the clinic is very primary in that it relies on manual labor over the fast efficient technology.  I took a break for some Swahili donuts and delicious, sweet chai, and then rushed back into the labour ward as a SECOND birth was about to occur.  This time a woman from the Massai tribe was giving birth, and it is part of the tribe’s tradition to deliver in the squatting position.  This was quite an interesting birth as the baby came out and appeared to be dead, with the umbilical cord tied around her neck.  It made no noise nor ostensible movement for 30 minutes.  I was aiding in suctioning, rapidly stepping on a pedal and shoving the plastic tubes up the baby’s nose and into her mouth to draw out any mucus that may be blocking her respiratory system.  My heart was racing for 30 minutes and I was positive that the baby was born dead.  However, she wasn’t- thank the lord. After constant resuscitation and suctioning, she began to breathe. I was taken aback by the fact that the mother was given no pain medication, the baby was given no ointment for her eyes, and most notably, that upon viewing the lack of response by her child, the mother merely sat staring at her dead-appearing kid with a poker face–no emotion whatsoever.  About an hour later, a third birth occured, this time an episiodomy, which is a surgically planned incision of the perineum and posterior vaginal wall that occurs in the second stage of labor.  Again, I helped with suctioning.  The suction is essentially a pedal with an attached plastic, cone-shaped tube – aka a piece of crap.  That day at the hospital I also witnessed a woman suffering in labor, on bedrest, and writhing in intense, excruciating pain that could not be absolved by the means of the clinic.  In the US her pain surely could have been prevented to an extent, but the lack of proper anesthesia made this impossible at the Clinic.  Today was by far the most interesting day I have had yet, as I was able to witness 3 births and learn of 4 (one birth occured at 6 am, before I arrived, and the mother was discharged just a few hours after). My experience today taught me that I do not want to be a gynecologist, especially in Africa where the systems are weak, materials are inadequate, and miscarriages are the norm.