13/8/08 or 8/13/08:  Trip to the  Kisuma Outreach Clinic

  Biharamulo Hospital runs outreach clinics each week to rural ( relatively speaking) villages. On Wed 8/13 we traveled to Kisuma for a well baby and  pregnancy clinic.  It was time I got  out of the Hospital and I was pretty excited  to get take a trip in one of the hospitals  2 white Toyota Land Cruiser ambulances. These are definietly THE vehicle to have in Tazania.  This one is probably as old as Bob Kramers Land Criuser back home ( cerca 1990) with HUDAMA YA WAGONJWA written on all sides and an antenna on it that looks like you could talk to Mars. I had  asked one of the drivers a few weeks ago what hudama ya wagonjwa means.  Being mister smarty pants and a budding Swahili linguist I said " does that mean wagon for humanity?"  In his best English he turns to me  and says "no no, it means ambulance".

   I was actually kinda glad that that crazy mirror image  idea of writing ECNALUBMA on ambulances  hadn't made it to Tanzania but then I realized why should it? There are hardly any cars here and  who uses their rear view mirror anyway?

  We were suppose to leave at 8:00 and left at about 9:15.. not bad for African time. I was traveling with 5 nurses and the driver. Which in fact means one midwife, one anesthetist, two

 pediatric nurses and one who just does vaccinations.  Everything  in Africa is an adventure and

 the road trip to Kisuma proved to be  no exception.  The driver said the trip was about 40km... I  multiply .6 x 40 and say 24 miles, not to bad. We arrived about 10:15. Thats about 24 miles per hr. and it wasn't because of  bad traffic.

    Sometimes the journey really is the destination.  The journey to Kisuma  was unforgettable and the day could have ended right there and been enough of a lifetime experience but  west still had a job to do. We started out on the red  dusty road from Biharamulo. The nurses had offered me the front seat which I politely declined even knowing that to sit in the back seat on one of these trips is the kiss of death: the red dust, back injury and jeep sickness. We were doing alright when I noticed the anesthetist in the back with me  was looking a little pale. Not a good sign for an African. A few mins. later he was barfing  his breakfast in the back of the  hot dusty jeep. Soon we turned off the big dirt road onto a trail that was just 2 strips of dirt and tall grass in the middle. The road to Kisuma is not a heavily traveled thoroughfare.  For the next 40 mins we did some serious 4 wheeling, good enough for any Toyota commercial. After about 30 mins, we see some women  and children ahead. We slowed down to pick them up. I figured we were real close to the clinic. For the rest of the drive we picked as many women and children as we could,  until we reached Top-Toyota-Human-Capacity. Thats 14 adults and 4 children...18 people in a Land Cruiser bouncing ( and I do mean bouncing)down a dirt path  to a village in western Tanzania. What a ride!   

  We crossed 2 small creeks, went up and over a few hills and dropped into Kisuma.  The village sits in a flat valley floor surrounded by wooded hills. It looks like a typical Hollywood African village, grass and mud huts, no telephone or electric lines, no cars, almost too Hollywood, but it is real.  My excitement is showing and the anesthetist, who is compacted next to me, says 

 " You're going to love this. This is the real africa."   The whole village is surrounded by a sea of tall golden grass that is bone dry and looks like a huge fire hazard. I keep telling myself I have to stop thinking like an American who has seen too many "California fires" on the news. It has rained once since we've been here  and looks like it hasn't rained in Kisuma for months.  If a fire starts here, Kisuma is toast..literally.

  Our job  today is pregnancy checks, registration, nutrition, malaria and Tb prophylaxis, new baby examination, which includes wt. check and immunization. My job is to take care of any sick kid or mother and decide if he or she has to come back to Biharamulo. I've told them all  I'm not a doctor and I really don't do ob-gyn  and I'm here to learn from them.  But to them I'm the American mwazugu daktari.

  For the next  4 hrs we see an endless line of pregnant women and mothers with  newborn babies. The "clinic" is a 3 room mud  building with grass roof and dirt floors. The exam room is a mattress on a raised wooden platform that sort lists to the left ( see pictures).  There's a immunization room ( screaming room). Outside the hut is the "weighing room", a scale tied to a tree limb with a meat hook to which you attach the new born who is put into a big pair of shorts that hang from the meat hook. Its pretty comical but it works and the mothers love it. They know wt gain is best marker for health. I meet the local  medical officer, Francisco, who looks like Chris Rock. When I tell him that, he has no idea who Chris Rock is but takes it as a compliment  "...american millionaire.."  The system works, the women and children  all have paper  medical cards that documents wts., immunization status etc. They know the cards are important and I hear no complaints about "losing my card".

Chris Rock is very interested in data, number of pregnancies, number of  immunizations, number of newborns. I see a future epidemiologist in him ...for Africa, for the WHO. But somehow, I don't think he will ever get out of Kisuma. 

  The day is hot and dry, the pts. continue to come (from where?) I spend a lot of time at  the "wt. room". There I can see every kid in good light and get a look at them as they are hoisted up onto the hook. I'm secretly looking for congenital heart disease, underdeveloped and SOB kids. I see none,  all the kids look good. A few umbilical stump infections ( soap and water) and conjunctivitis and rashes but no seriously ill or malnutrient babies. No problem pregnancies.  No malaria!  I was all set to bring back a bunch a sick kids in the ambulance. Today is a good day.  

  At 4:00 PM it is over. The pts. stop coming. We have to leave and all those young mothers have a lot of work to do. I review the data with Chris Rock. Kisuma has 2,300 +/- people. We have just seen 70 pregnant women and weighed and immunized 105 kids. I know there are more pregnant women out there and there are kids that will be born tomorrow and that some children will die before they reach  their 5th birthday. But as a rough indicator that is a birthrate of 7.6%.  Epidemiologist Rock thinks Tanzania is growing at "about 9% and it would be 12% without AIDS".  Is he right? 

  Its a long bumpy  trip back, we are tired and dirty, my white coat is  a shade rustier. The anesthetist, who spent the whole day in the jeep, has stopped vomiting  but now is achy and has a fever. I ask him if he thinks he has the flu. He says no "its probably malaria".  He's probably right. He then asks me what I thought of the real Africa. I tell him it was just what I wanted to see, to experience, but inside I'm thinking why does the "real Africa" have to be so poor .....