Today’s journey began with a trek to the hospital grounds – I planned to knock off a few minutes of the walk by going in the back door that I saw many “uniformed” hospital folks using. Two wrong turns and I was in the storage area at the basement of the hospital – men in rubber boots looked at me curiously but simply smiled and extended greetings! Backtracking, I found the error of my turns and made it up to surgical two for “resident rounds.”
A retired local orthopedist and I were the senior members of the rounds this morning. There were several admissions overnight, but thankfully the scale of the trauma was diminished from the previous rounds.
Trauma tales include motorcycle injuries, pedestrian vs car injuries, a kick from an elephant, and simple falls.
I had resolved on my walk to approach rounds with renewed vigor and not wait to be asked or recognized. I launched into discussion of femoral neck non unions (the presented X-ray had bilateral old femoral neck fractures with an acute intertrochanteric fracture), followed by management of acute ankle dislocations, and ending with a discussion of an 8 month old L1 vertebral body fracture in a paraplegic. I found that many seemed interested and asked appropriate questions.
Now, blazing with confidence, I told the interns I would accompany them on ward rounds. They began scurrying around and it became apparent that I was the only non-intern on the ward – we were still on holiday schedule. I was presented with a 3 day old admission of “pyogenic spondylitis.” (Exactly what this foot and ankle trained specialist had hoped to discuss.) We began a journey into infections of the spine when my phone chimed and the taxi driver who was to get the family to town could not locate them! I excused myself from rounds briefly – saved by the need for a phone card!!
Intermission –
My ATT international plan had served us well, but we hoped to get a local SIM card as the data costs are significantly lower. Mrs Tree and the boys had tried to get a card this morning at a nearby “top-off” tent for VodaCom. What in the past has been reported as a simple purchase with your passport number was unsuccessful. Apparently, Tanzania has a new 20 numerical digit personal ID – similar to our driver’s license, and this number is required to get a SIM card. While this had been publicized by the government to its citizens, the rule actually went into effect… TODAY. The VodaCom rep at the tent had no idea how to get us a card. He tried several times with his handheld and told us to come back later in the afternoon.
Finding Mrs Tree nearby, I was able to connect her with our driver and they headed into town. They met large lines at the central Vodacom office and again flustered sales reps. The problem was solved when our driver allowed her to use his number to get a SIM card. Perhaps she will fill in the details later…
Intermission Ends –
I returned to the ward to complete rounds, but the interns had scattered. They rotate through various fields every three weeks, and none of the nurses knew how to find my “spondylitis” intern. I searched for a bit – but just like in the US, if the work lets up and you’re an intern you become invisible. I left a note and headed to the orthopedic outpatient clinic.
I found the clinic and asked a resident who I recognized from rounds how I could help. He asked if I had computer access – which I do not, but I explained if he found me a medical student we could figure it out. The resident logged us into a surprisingly modern EMR and my medical student (Dr Max) and I began seeing patients. Soon we were joined by Dr Jessica, Dr Peter, and several others. I was now teaching 8-10 4th year medical students in basic orthopedic histories and exams. We saw many patients with a wide range of problems. With Dr Max’s help, I was able to record their visits – perhaps… The clinic turnover was slow, so we had time between patients to review other fracture care points and exam techniques. They were attentive but very quiet. I finally joked that one of the students was Lionel Messi and that he had hurt his knee. “Mr. Messi” and I went through a knee exam, and that bit of humor seemed to do the trick. Now the questions began. The expectant idealistic questions were fun and infectious. “What is the best way to treat a fracture?” “Which is better traction or external fixations?” If I could only answer those questions, but hopefully we started a curiosity and comfort level that will allow them to ask more over the next few weeks!
(My wayward intern and I met again in clinic. She had seen a local staff doctor who confirmed the need for an MRI for our ward patient. I am not sure she believed my story of finding my wife, but c’est la vie)
Clinic came to an end. I journeyed home. We were visited at our house by one of our guides from our climb up Mt Kilimanjaro last year. Awesome to see him! We also were contacted by a local orphanage and the boys will be able to help there later this week. Progress is happening.
The kitchen is stocked. The electricity is on. I am posting this blog via my wife’s newly acquired local SIM card. Easy, no. Successful first few days, yes.
Tomorrow is a holiday – Happy New Year. We hope to journey to a touted nearby waterfall for a picnic and sightseeing