Moshi Mwika Madness

24 06 2010

Moshi town! Going back to city life is a definite adjustment from rural Mwika Uuwo. Austin, Wendy, and I had our first experience using Tanzania’s public transportation. We boarded a packed bus bright and early Wednesday morning and rode our bumpy way down to Moshi, reuniting with Clara and Daniella at KCMC about 2 hours later. Here in Tanzania, travel time definitely has to be factored into the schedule. At the medical center, some of us went to the maternal ward while Wendy and I observed Sumera at the PMTCT (Preventing Mother to Child Transmission) HIV clinic there. She and her husband, Dr. Jeff Wilkinson, are Duke physicians who have been at KCMC for 2 years, working in maternal and child health. We saw 5 patients at the clinic, all healthy looking mothers with young adorable children (some we got to hold!).

Exclusivity in terms of infant feeding is very important for mothers with HIV. Sumera shared with us the fact that although babies who were exclusively breastfeed had a 33% chance of getting HIV through their mothers, exclusive bottle feeding can decrease a baby’s life expectancy due to unclean water in the formula. Neither option is great, but either is better than doing both. What’s very helpful is that the patients are given blue cards with all of the pertinent HIV/AIDS information on the patient so that any healthcare facility can have easy access to medical history. The AZT drugs are free here (made possible through programs like PEPFAR). However, Sumera noted the troubling reality that if they’re free, people are less likely to take them since the drugs don’t seem to be as valued, and this leads to more resistant HIV. The patients should ideally start with AZT at a CD4 count of 350, but sadly there aren’t enough drugs here so CD4 less than 250 is the criteria. In most of the clinics in Tanzania, there are only enough first line drugs, not second line, but KCMC is an exception, with both available fortunately. Viral counts aren’t available even here, though, as they cost $50/test.

After we saw the last patient, we met up with the others and had the opportunity to see an obstetric fistula, a childbirth condition caused by prolonged labor. A hole is created in the mother, which can lead to constant leaking of urine or feces. This condition is rare and preventable with Western healthcare but here, the services are limited and transportation options few. Dr. Wilkinson treats these patients through fistula repair surgeries at KCMC. The fistula case we saw was rare, as the patient had polio (her right foot was shriveled) and had three more successful births after having a fistula from the first birth. Babies are stillborn in most cases. After having lunch at the medical college nearby, we went into town to do some errands and eat dinner, and later in the evening, we visited Dr. Wilkinson’s place for a nice chat before they headed back home to the US on Sunday.

The next day, we met up with Sarah Wilson, a researcher from Duke doing a study on obstetric fistula at KCMC, who gave us advice on our project.  We’ve developed a questionnaire that we can hopefully use at Mwika Uuwo. The questionnaire is on stigma and knowledge of obstetric fistula as well as knowledge of HIV/AIDS. We hope this will help the clinic get a sense of the services the clinic should continue as well as begin to provide. We had lunch with Clara and Daniella at a delicious Indo-Italian restaurant recommended by Sumera, and then it was off to Mwika Uuwo in a dala dala (the most common mode of transportation here, a small van oftentimes decorated with a saying/blessing on the back).

We had quite a day on Saturday. Combine a long trip up the mountain to Rambo (Mama Nancy’s hometown) in a Land Rover, a forest with monkeys, a beautiful waterfall, the jeep breaking down, a funeral, dehydration, and a living room, and the result is three exhausted but happy travelers. We visited Mama Nancy’s father in Rambo, all the way up a mountain, and they have a gorgeous piece of land with monkey-filled trees and a great view of a natural waterfall. As we headed back, the jeep broke down so we had to walk through the village and ended up at the funeral of two villagers. Wendy almost passed out due to dehydration and walking/standing the whole day, but we had water available luckily, and everything was fine. After the funeral, the Land Rover was back in business, and we rode our way back down to Mwika Uuwo, stopping at the nearby shop to relax. What’s special about Tanzania and this day especially, is that preoccupation with the future doesn’t seem to exist. It definitely makes things more interesting when you don’t worry about what will happen next. This lack of urgency, however, has its downfall, especially when you place it with medical care.

Now that we’re back in Mwika Uuwo, we’ve been helping out whenever we can around the house after 9-3 at the dispensary. Mama Nancy has this neat shaver on the side of a small wooden bench that we shredded coconut with for dinner. We’ve helped shell peanuts, and yesterday night, Wendy and I helped make delicious banana fritters. At the dispensary, we’ve been able to shadow the doctor and interact with the patients. We noticed that almost all of them are treated for malaria (it seems as frequent here as the common cold in the US). All the patients are better within days, which is great. The regular treatment regimen for malaria here is 6 doses of quinine by IV, then tablets for 5-7 days, and Malafin afterwards. We have shadowed at the Maternal Child Health (MCH) clinic upstairs, open Mondays and Thursdays, which does family planning, counseling, and testing. There is a PMTCT program here, too, but AZT drugs and therapy for HIV patients aren’t available. The mothers have to go to Huruma or KCMC for treatment.

Today we started organizing the medical records, which date back to 2002. The clinic saw more than 2,000 patients in 2002 (we’re still sorting through more)! The surprise of the day was finding a dead rat behind the cabinet along with termites eating up the medical records. We solved the rat problem quickly though, and the clinic staff said they were bringing insecticide when we left the clinic for the day. There’s still much to do here, but we’re looking forward to getting our shoes dirty.

– Tammy Chin

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