Manguzi Medicine

Before I left for Africa, a good friend gave me a necklace with an inscription on it that reads “All the strength you need is right there inside you”.  I can’t tell you how many times I looked down and read that necklace today.  At least a hundred.  For better or for worse, my experiences here the past few days have forced me to find a strength I didn’t know I was capable of.  I have actually been avoiding writing a blog because I didn’t want it to be too sad.  But then I realized that it is all part of my experience here at Manguzi, and should be remembered and shared right along with the good times.  I promise not to dwell on it too long during this post, but I do want to share a glimpse of what medicine and life is like for some people.  It is a true blessing to live in a country where, despite the current health care crisis, anyone can walk into an emergency room and receive quality, life-saving care when needed.

Today, I saw my first “active” death.  Not someone who had been ill for a long time and was known to be dying, but someone who was well yesterday and arrived at the resuscitation unit in critical condition.  He was 17.  Although all of the doctors here are smart, well-trained, and passionate about their careers, there is nothing that can substitute for experience when faced with a true emergency. Unfortunately, although many doctors come here to do their required year of community service just after finishing their training, Manguzi struggles to keep anyone after that year.  This means that the majority of the staff have, at most, 1-2 years of experience treating patients on their own.  This particular patient would have died no matter what, but it was scary to see how slowly things moved in a crisis situation.  It makes me realize that, while I may have learned more than I thought possible the past two years, I still have a long ways to go, as does most of the staff here. In my four years of medical school in the states, I have only had one patient die unexpectedly.  In the past 24 hours here, I have seen it twice. It has been sobering, for lack of a better word. 

Practicing medicine here has also made me realize how much there is to be grateful for even in the most inner city hospital in the states. Yesterday, I looked for 45 minutes to find a functioning otoscope so I could be certain a patient had an ear infection before I wrote for antibiotics.  It is a daily gamble whether or not the nurse assigned to your unit for the day will be even remotely competent.  There are a few fantastic nurses, and it is amazing how much better the day goes when you are paired with them, but most are not even slightly interested in doing their job. The patients are actually responsible for carrying around their own medical records here.  This means we have to rely on them to have their papers on them to have any sense of their medical history.  To be honest, I’ve been surprised by how many of them actually do have the proper records.  However, it would be much more helpful if any of the writing in them was legible and physicians weren’t trying to cram years of medical visits onto what is essentially a notecard.

I don’t mean to put a totally negative spin on Manguzi medicine.  It has definitely been a learning experience, but mostly not an unpleasant one.  Every day, I am amazed by what we are actually able to accomplish with such limited resources.  The majority of patients here do quite well.  It’s remarkable to watch how dramatically a patient can turn around once they are receiving proper treatment for their conditions.  One child on the pediatrics ward was too weak to even sit up on his own last week and today he came toddling over to me carrying his bowl of porridge to share. (I passed on that offer J).  Another mother told me that today was the first time in months that her child had laughed.   Those are the moments that help me get by on a day like today. I have to remind myself that, if it weren’t for rural hospitals like this, most of those children would not survive.  Though the patients you cannot save definitely stand out far more, they are, fortunately, the rarity.  Practicing medicine in Africa definitely requires looking at the “big picture.”

Another nice thing that comes with such an underserved and understaffed hospital is the chance to have far more autonomy than we would ever be allowed at home.  It turns out that, with my several electives in inpatient pediatrics this year, I actually have more pediatric experience than many of the doctors here.  At home, it is very unusual for a resident or attending to ask a student for their advice or opinion.  Here, it happens all the time.  There is much more of a feeling of teamwork amongst the physician staff than at any other hospital I’ve worked at.  Everyone’s strengths are well known, and no one hesitates to ask when they know someone else has more experience or knowledge of a topic.  Even within the four of us medical students, we each have our own areas of interest and frequently run ideas by each other before we treat our patients. The low number of staff also means we get to do a lot of procedures.  I did my first successful spinal tap today and Bryan did several (he’s much better at them than I am).  I’m also getting lots of practice at putting in IV lines, suturing, and administering various medications.  In terms of experience and education, I don’t think we could have picked a better place to spend a month.  And though it’s not been easy, I think we have all found that we have the strength to face much more than we expected.

To end on a happy note, we had a German dinner gathering last night.  Our friend Jonas (who is from Germany) cooked schpaetzl for about 25 people.  That is A LOT of schpaetzl.  For those of you with a lack of knowledge of German food (like me), it is essentially a macaroni and cheese with homemade noodles and caramelized onions.  And it’s delicious!  I foolishly offered to help cook which was fun, but when you are cooking for that many, using all four burners and the oven, it gets miserably hot in an un-airconditioned kitchen.  We served it up at our place and sat out by the pool to eat it.  It was a really fun evening.  Tomorrow, we are going to nearby Kozi Bay which is along the Indian Ocean.  They have hiking and snorkeling, and we are going to have a braii (barbeque) on the beach before we head home. We are off to Mozambique on Friday for the weekend, but hopefully I will have a chance to do another post before then.

Hope everyone is well. I promise the next post will be much cheerier and have a few pictures as well. Miss you all!