Thursday, 22 December 2011

Elective 43. The tower

Today we meet some unconventional diagnoses and management plans on the ward round, and I buy myself some medication. We go to give some gifts to the primary school, and medically treat one of the kids playing outside out house, while getting heckled by pregnant women. We finish off the day with an intrepid climb up the water tower near our house.

The sunset from behind our house is beautiful as we come back from the water tower.

On the ward round this morning, we encounter an 12 month old child who had presented with 'headache and chest tightness'. Dr BT had admitted him into hospital with these complaints. I am not sure how he found out this baby had 'chest tightness', or even a headache, but he clearly decided metronidazole was the best drug to treat this presentation (very unlikely to be correct). The baby looked fine to us, and all tests were negative, so he was discharged. This was a nice money earner for the hospital, as admissions incur a large charge, but not such good news for the parents. I am sure he didn't admit on purpose to get the hospital some much needed funds, but you do wonder. Metronidazole should be most commonly used here to treat bloody diarrhoea or pelvic inflammatory disease caused by an untreated STI. I am guessing Dr BT didn't think the child had the latter, so perhaps he had deduced that the diarrhoea the child didn't have could have spread to the lungs and head? In some ways, I cannot wait to get back to the UK, where things make sense.

The second 'odd' case was admitted while we were on the ward, so we saw her as soon as she came into the ward. She is a 15 year old schoolgirl, and had come in from the school (it her first day there) with central chest pain and rapid breathing. The doctor who had see her in outpatients had written down "?Angina. Urgently to be seen by ward doctor". Pretty sure that it wasn't a heart complaint in this healthy looking girl, we did a full examination and history anyway. This was helped by the fact she spoke a few words of English, as she went to the school where English must be spoken at all times. The examination seemed to show she was fine, and the history seemed to fit in with a panic attack. Not really sure what to do, and needing to give medication (silly Tanzania) we gave her salbutamol tablets and antihistamines in case its some kind of allergic response or asthma attack. Once admitted, the hospital rules are that the patients cannot be discharged in the first 24 hours, so she is left in the hospital for a day. Perhaps a good thing, as it means she can be checked to make sure there is nothing severe wrong with her. A 15 year old with angina though? Very unlikely.

Later on, when things have quietened down in the ward, I saunter over the the lab to have my full blood count taken by Choc. An expensive test for a Tanzanian, but only a couple of quid for me to see what my blood looks like. Sounds like a fantastic deal, though I am careful to make sure that my blood is taken with a clean needle! It turns out that after these 6 weeks in Tanzania I have become anaemic. Microcytic anaemia - the classic finding here on blood tests. It must be the lack of iron in the blood, or perhaps I have a hookworm infection. My iron is still very high for a Tanzanian person, but is a little below 12g/dl, which would make me anaemic in the UK. Not much I can do about that, apart from eat lots of delicious food once I get home. I cannot wait!

In my spare time, I also pop into the pharmacy to get some medications to take home. Because I have been washing in the lake water all this time, which does have the parasites that cause schistosomiasis in it, and because everyone here seems to have a worm infection, I get two drugs from the pharmacy to treat  schistosomiasis and worm infections. I will take them once I get home, hopefully meaning I can be nice and healthy when I return. I don't think I have caught anything nasty than a few stomach bugs when here (apart from that nasty tonsillitis), but much better safe than sorry!

We travel to the primary school that is further on into the village in the afternoon, with the intention of dropping off the stationary that I bought with me, and Kiwi and Dolittle's pencils they bought along as well. What was intended on being a quick stop and drop then back to the hospital, quickly turned into a tour around the school where we spoke to each class room about ourselves and they all said hi, or asked us questions. It was pretty embarrassing, though really sweet. Whatever classes were going on at the time were interrupted for us to come in and talk about ourselves. Proper little minor celebrities!

The primary school children expect us to talk about ourselves to them, despite the fact they speak very little English.

Once we get home, we are playing outside with the kids again. I notice that the hyperactive one (Kev) has been leaving bloody heel prints across our porch, so ask to take a look (well, more gesture, seeing as we cannot talk to the children at all what with the language barriers). He has a large cut on his heel, which after some gestures, I think he got after trying to ride someone else's bicycle. I was all of the sand and grit out of it, sterilise it and then put a bandage onto it to stop it from getting more grit into it, and hopefully to stop it from bleeding. As I start doing this, some pregnant women are walking by the house, and stop to watch, sitting on our porch and under the tree in front of our house. They start shouting things to me, and laughing amongst themselves, though I have no idea what they are saying. I cannot really answer with some witticism, so just keep quiet and bandage away. He thanks me (very rare for Kev) and scampers off after I am done, and I go inside. The pregnant women do not, though, and instead spend some time staring in through the windows at us. We try to retreat to other rooms to avoid their gaze, but they then track around the house to find windows looking into those rooms to continue staring. Its a little like being at the zoo! This only stops when our cook arrives to cook dinner for us, and they all flee from her accusing shouts. I wish I knew what was said. 

Some of the women who were heckling us leave, with their collected fire wood.

As the dinner is prepared, I decide that I would like to climb the water tower behind our house. This water tower hasn't been used in years, though was originally put in to try and supply houses with running water. It has a ladder up the side (starting about 6 foot from the ground) and as it is already on high ground, I imagine it would give wonderful views. I persuade Dolittle and Kiwi to come with me, though they assure me that they are unlikely to be doing any climbing up the tower! I feel happy that they will be there, though, and if the ladder breaks or something nasty happens, I can get some medical treatment from them. I also tell them that if something happens, they need to get me to a hospital in the city, rather than let me be treated here! Once at the water tower, and I have climbed up the rickety metal ladder (stick in hand in case of snakes waiting at the top to bite my face) they decide they would also like to come up. With the help of some boosts, they make it to the bottom rung of the ladder and can easily climb to the top. The view is amazing, across the rift valley on one side, and looking at the hospital, the village and the house we live in on the other, covered by a beautiful setting sun.

The view from the top of the water tower, my house is in the middle of the picture, with the hospital behind it, and the rest of the hospital spread out to the right.

Once we are bored with the view, and it is getting dark as the sun sets, we return home for dinner. After dinner we play a 'heads, body, legs' game where each person draws a specific one of these three, linking them to each of the other persons other body parts, blind to what they have drawn, to create amazing (or abominable) creations. These two girls are a lot more fun than Sporty and Smartie were, and we have a lot of fun. See some of our strange creations below!

I am very proud of my man-on-horse idea and House ideas. Very original, and the house works so well with the smartly dressed top! Wonderful.

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