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.
CWP

Travel Pix from July 4th

It is hard to believe that exactly one month ago Jan and I (along with Muller and Wally) were traveling from KC to Tanzania.
Here the boys are looking out the window as the plane is taking off from Amsterdam.

The flight was during the daytime and the weather was cloudy over most of Europe but started to clear to show the Alps as we got closer to the Mediterranean.

The Croatian coast was visible from our side of the plane.

Looking down at mainland Greece.

A view of the Kissamos Gulf and the Gramvousa and Rodopos Peninsulas on the Island of Crete.

Another view of Crete.

The Sahara Desert in Egypt is our first view of the African continent.

The Nile in Egypt just north of the border of Sudan (near the city of Abu Simbel).

This part of the Nile is the southern part of Lake Nasser, the world's third largest reservoir that is created by the Aswan High Dam (located farther north on the Nile and not visible from the plane).

Safari Pix from Jim

Safari Pix from Marlene

Marlene shares about the group in her safari car,

"Our driver was Freddy. The most memorable event was Bob Schroeder cracking his head on the roof of the van when we hit a major rut! It was interesting to watch Jared stand on the floor of the van to see out over the front luggage while Erica stood on her seat to see out."

"Another memorable moment was when Freddy and Jared jumped together at the Maasai village."

"The first sighting of any new animal was always a thrill. We finally learned we should trust Freddy to get us to a good photo op spot."

Marabou Storks

While staying at the Uruhu Lutheran Hostel in Moshi, Pastor Joe, Jan and I saw strange large birds in a tree on the Hostel grounds.

It turns out that they were Marubou Storks and we would see more of them during our trip. These storks were seen on the rock formations above the Mwanza road as we were driving to dinner from the Sukuma Museum.

More storks in line to take off from the rocks of Mwanza. The Marubou can reach a height of 60 in, a weight of over 20 lbs and have a wingspan of at least 10.5 ft. - it shares the distinction of having the largest wingspan of any landbird with the Andean Condor.

This stork was spotted while on safari in the Serengeti. The Marabou is unmistakable due to its size, bare head and neck, black back, and white underparts. It has a huge bill, a pink gular sack at its throat, a neck ruff, and black legs and wings. The massive bird is often claimed to be one of the ugliest creatures in the world.

Safari Pix from Jim and Cindy

The group from this car shares some pictures below from their safari adventure plus a couple other misc pix from Nyakato. Their driver's name was Grayson, he is a Lutheran and sings in the choir and his father is a retired Pastor who teaches at the University.

My Favorite Souvenirs

My favorite souvenirs from the trip would have to be my hats, my bracelets - and of course my pictures.

Throughout the past week I have been wearing my bracelets and people have asked about them. Certainly, people at work have been inquiring, but one evening this past week at a retail shop, a clerk asked if I had made my bracelets, I had to respond that the Masai tribe in northern Tanzania had made them and that opened a whole new opportunity to share about our trip and our mission.

Yesterday as I was leaving work a colleague asked about my bracelets and I told him about them being from the Masai, and I even had a print out of our group at the eye clinic construction site. He was intrigued and said he wanted me to come by next week and tell him more about our mission and the trip.

This morning I was in a creative workshop and I wore my knitted Tanzania cap - of course everyone wanted to know about the trip - and I had the opportunity to use some of my African experience in my pieces.

Later this morning on my way home I stopped at a garage sale - again the questions about the hat and bracelets. What simple things like bracelets and hats can ignite conversations that otherwise would never happen.