Wednesday, August 5, 2009

Excerpts from Dr. Powell's Journal

Dr. Powell working with Isabella, a visiting med student from Austria.
July 13th:
The real work starts today. The clinic is seeing between 60 & 100 per day. There will likely be more since they announced in church that there are doctors visiting. I may learn how to do circumcisions this week. There is a big push here with government money due to AIDS. Circs reduce the transmission rate.

Paula is giving the M4M Team a tour of the birthing center.
The overall plan here is amazing. They have a comprehensive layout for a complete hospital and all the land is purchased. The birthing center is framed and roofed but not open as yet. They have plans to open the first neonatal intensive care unit in the country here. The state of neonatal care is horrible at the government hospitals. If a baby is depressed or apneic at delivery, the just do nothing. The simplest measures are not done.

Busy in clinic. The diagnosis is malaria and... After that, complications of malaria, bad teeth - pulled right away, and even some H. pylori.

Bette helping MaryEllen organize one of the equipment rooms at the clinic.

Erika looking after supplies in another one of the clinic's equipment rooms.

July 14th:
Weather here is HOT, but not quite so bad as it could be. The altitude makes a big difference. It does cool off at night.

Bette and Erika are really whipping the OR equipment into shape.

Today's clinic was malaria AND typhoid day. We also had a 3 day old with worried parents. The baby was absolutely beautiful and as well as he could be. Mom had malaria though.

I also watched an African style circ today. I still don't want to do them. The conjecture here is that circs help prevent AIDS. The patient was 18.

Did I tell you that the birthing center has an NICU? I knew that experience was going to be handy in Africa one day. It's just not this trip...

July 15th:
We were greeted this morning with no electricity in the clinic. Lynne and I jumped and we saw patients on our own, with the help of a translator. The Tanzanian doctor had to go pay the electric bill!

Saw more malaria today (most everyone) but also saw a couple of minor injuries and another tooth extraction.

Father with daughter patiently waiting for treatment for her scalp.
We had a little girl with sickle cell disease today who had had a scalp IV that became infected and she developed necrtizing fasciitis. About half of the scalp was raw. I would have liked to treat with IV Rocephin but there were no IV sites and they lived too far away to come back every day. We treated with a single IM dose of Rocephin and sent her out on Cefpodoxime. The nurses that came with us did a good job of debriding and dressing the area.

Looks likely that I won't be sending this tonight because all the power in the region is out. First prolonged outage we have had. It is apparently due to the lack of water to run the turbines at the power plant.

The construction crew is more than 2 days ahead of schedule. They say that this by far the best crew that has ever been here. We have the outside walls framed, upright & nailed together. The internal walls are going up and about 1/3 of the roof trusses are assembled. I'm pretty impressed.

July 16th:
We are coming up on the last day of the trip's work portion. We saw much more normal kids today. A few cases of malaria but a couple of well kids too. I can see a lot of kids when you can document "normal exam" instead of the three page exam that is expected in the US. We also saw a fetal alcohol syndrome today. Some things never change.

Dr. Powell and Dr. Bon.
I had a chance to do some teaching with the local docs as well. They have considerable expertise in tropical medicine but we deal with many things they rarely see. Go figure.

The building and the interior walls are complete. Tomorrow the roof trusses will start going up. We ended well ahead of any expectations.

July 17th:
Aside from many cases of malaria, we saw several dental extractions. I would not be able to do that at gunpoint. The last fellow today was a most unfortunate guy. He had terrible decay of the back teeth with impaction from the overgrowth of gums. He had 3 teeth pulled. Needless to say, he was most uncomfortable.

We saw a real nursemaid's elbow today. It apparently is quite rare here and the local doc had no idea that it could be reduced with some simple manipulation. The boy also had malaria, so back to the original premise that it's either malaria, or malaria AND...

Carrie, med student from Colorado, and Dr. Bon.
Well, perhaps not always. We had a one month old baby that came in with a temp of 39C and fever since last night. She arrived just as we were picking up our things to leave. Now SHE was malaria negative with a high white count and 62% segs. We treated with antibiotics but there is no inpatient facility that would be suitable. Taking her to the local hospital would have been a death sentence. We have them coming back for daily antibiotic injection on ceftriaxone. Not exactly standard of care in the USA but the alternative is not pretty. We also were able to teach the local doc, (Dr. Bonaventura) something about neonatal sepsis and that all fever, however rare, is NOT malaria.

The Powell Family ready to head out to the Serengeti.
So that's how we ended our clinical work in Tanzania. Tomorrow we leave for our safari first thing in the morning. In some ways it will be a letdown. Nonetheless, it will be fun taking pictures of the animals. Enough for now. We just finished dinner. I need to wrap things up and get packed for tomorrow.

July 26th:
One final update on our 1 month old sepsis patient from the Nyakato clinic: I received an e-mail today that our patient, Happiness, completed her course of antibiotics and she remains fever free. Parents and grandparents are grateful.

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