Friday, 28 October 2011
The sense of an ending
So I read this in three nights because it was also so addictive. Some poignant quotes below that I liked.
A thousand splendid suns
The first book I read on a "kindle app" here. An excellent sequel to the kite runner.
Very hard to put down but so sad.
I hope the reality of life for women in Afghanistan - both urban and rural, has changed for the better
Very hard to put down but so sad.
I hope the reality of life for women in Afghanistan - both urban and rural, has changed for the better
The Zoroastrians of Zanzibar
What an interesting day yesterday was. After dad did a bit of detective work, and a few phone calls, we realised that Zanzibar's Zoroastrian temple, was still standing.
Established by Cowasjee Dinshaw and brothers in the Nineteenth Century, the community numbered no more than 150 people at it's height.
The temple was closed in the 1970's and currently only two Zoroastrians remain, and I was privileged to meet them today.
There was also a Zoroastrian cemetery which is sadly in a poor state of repair.
The Tembo House Hotel still bears the names of Cawasji Dinshaw, the building's one time owners, over it's entrance, along with portraits in the lounge.
Established by Cowasjee Dinshaw and brothers in the Nineteenth Century, the community numbered no more than 150 people at it's height.
The temple was closed in the 1970's and currently only two Zoroastrians remain, and I was privileged to meet them today.
There was also a Zoroastrian cemetery which is sadly in a poor state of repair.
The Tembo House Hotel still bears the names of Cawasji Dinshaw, the building's one time owners, over it's entrance, along with portraits in the lounge.
Wednesday, 26 October 2011
Parasitology...
Is hard when you only have about 9 hours of teaching before your diploma exam! Help!
The end of an era
So we are at the end of our time in moshi.
Last week was pretty heavy - lots of hard parasitology followed by the dreaded exam on Friday. Thankfully the stress of the week was relieved by the best weekend ever, in Tarangire national park and then the spectacular Ngorongoro crater. What a sight.
And now - off to Zanzibar for a week of R and R.
As for Nairobi, it's a bit of an open book at the moment, whether we go or not. If al-shabab continue their terrorist attacks then we may well not.
Will keep you all posted.
Last week was pretty heavy - lots of hard parasitology followed by the dreaded exam on Friday. Thankfully the stress of the week was relieved by the best weekend ever, in Tarangire national park and then the spectacular Ngorongoro crater. What a sight.
And now - off to Zanzibar for a week of R and R.
As for Nairobi, it's a bit of an open book at the moment, whether we go or not. If al-shabab continue their terrorist attacks then we may well not.
Will keep you all posted.
Tuesday, 18 October 2011
Kate's a mum!
I am so proud to say that my dear dear dear friend, Lady Katherine Malhotra (nee Medlow) of West Chelsea (Parson's Green), who got me though medical school and continues to tolerate me, gave birth to a love little healthy girl this morning x
So yes, it
has been ages since I last wrote. Partly due to exhaustion after our week away.
We arrived back in Moshi on Sunday night, sadly other groups got stuck in the
mud and had to be shipped out by boat and then local bus. Proving how hard
access to anything is, when you don’t have surfaced roads.
On return,
half of our week was spent preparing our verbal presentation and finalising the
written report, a picture of which i’ve put online (all 116 pages of it).
The rest of
the week was spent on malaria teaching, and it was pretty shocking. This one
illness doesn’t kill for the obvious reasons, and it doesn’t target the obvious
groups. The take home message from Dr Baz Nadjm and Dr Tom Doherty, was that it
kills children, mainly under twos. And if you make it past that age, whilst you
may well get severe malaria later, you are less likely to die from it. The
other sad fact was that the reason most people die is that they just do not get
to healthcare facilities in time. There is a lot of malaria that is never seen
because people die in the community. We estimate approximately 2000 lives a
day, yes, a day, are lost to it.
Finally,
our other take home message was that we are massively overdiagnosing malaria
without testing people first – and missing other important killers as a result.
In my study group at Pangani, we found that four out of five people who were
treated for malaria we not even tested, and may well have had other problems.
And of those who were lucky enough to be tested, in whom malaria was suspected,
half of them didn’t have it either.
Lots of
food for thought there – if you want to know more, you can read our report!
As for the
weekend, well a rather lively night at the “Glacier”, sprinkled with generous
amounts of Konyagi, led to a ceilidh on the roof of our hotel, and sore heads
the day after.
Sunday
however was incredible. I saw giraffes. Wow.
Wednesday, 12 October 2011
Tropical medicine in a nutshell
Why does this person
Who has come from this place
Develop these symptoms
At this particular time?
---
Prof Eldryd Parry
Who has come from this place
Develop these symptoms
At this particular time?
---
Prof Eldryd Parry
Tuesday, 11 October 2011
Rural visit to dispensary
So today we visited a village 66km away from Pangani, which itself is in the back and beyond. No running water. No power. No latrines.
Why?
Two cases of measles sent to us in the last 2 days.
All children should be vaccinated but uptake is scanty.
We performed, after our 2 hour 4x4 journey involving a boat across a river, and house to house search for other possible cases.
1 definite (with koplik spots - only the second time I've seen them) and several suspected.
The advice - to keep cases here for management to contact the infection.
We also visited the dispensary itself - which was actually fairly well stocked and not busy at present. One problem - poor communication with the district hospital at Pangani. No phones or faxes - the staff just use their own mobiles at their own expense - which is a deterrent given the cost of calls here.
I am exceedingly hot and tired after just three hours in sun.
Ps did you notice the mosquito net placed next to a fishing net? Sadly the district medical officer (the only doctor at Pangani hospital) also reiterated that out of all the nets he'd distributed, for free, not a single one was in use (at least, for the purpose for which it was intended). He also explained how local beliefs prevailed and that people thought that both vaccination programs and impregnated mosquito nets were a ploy by the government to render the population impotent and infertile.
Why?
Two cases of measles sent to us in the last 2 days.
All children should be vaccinated but uptake is scanty.
We performed, after our 2 hour 4x4 journey involving a boat across a river, and house to house search for other possible cases.
1 definite (with koplik spots - only the second time I've seen them) and several suspected.
The advice - to keep cases here for management to contact the infection.
We also visited the dispensary itself - which was actually fairly well stocked and not busy at present. One problem - poor communication with the district hospital at Pangani. No phones or faxes - the staff just use their own mobiles at their own expense - which is a deterrent given the cost of calls here.
I am exceedingly hot and tired after just three hours in sun.
Ps did you notice the mosquito net placed next to a fishing net? Sadly the district medical officer (the only doctor at Pangani hospital) also reiterated that out of all the nets he'd distributed, for free, not a single one was in use (at least, for the purpose for which it was intended). He also explained how local beliefs prevailed and that people thought that both vaccination programs and impregnated mosquito nets were a ploy by the government to render the population impotent and infertile.
Rural visit to dispensary
So today we visited a village 66km away from Pangani, which itself is in the back and beyond. No running water. No power. No latrines.
Why?
Two cases of measles sent to us in the last 2 days.
All children should be vaccinated but uptake is scanty.
We performed, after our 2 hour 4x4 journey involving a boat across a river, and house to house search for other possible cases.
1 definite (with koplik spots - only the second time I've seen them) and several suspected.
The advice - to keep cases here for management to contact the infection.
We also visited the dispensary itself - which was actually fairly well stocked and not busy at present. One problem - poor communication with the district hospital at Pangani. No phones or faxes - the staff just use their own mobiles at their own expense - which is a deterrent given the cost of calls here.
I am exceedingly hot and tired after just three hours in sun.
Ps did you notice the mosquito net placed next to a fishing net? Sadly the district medical officer (the only doctor at Pangani hospital) also reiterated that out of all the nets he'd distributed, for free, not a single one was in use (at least, for the purpose for which it was intended). He also explained how local beliefs prevailed and that people thought that both vaccination programs and impregnated mosquito nets were a ploy by the government to render the population impotent and infertile.
Why?
Two cases of measles sent to us in the last 2 days.
All children should be vaccinated but uptake is scanty.
We performed, after our 2 hour 4x4 journey involving a boat across a river, and house to house search for other possible cases.
1 definite (with koplik spots - only the second time I've seen them) and several suspected.
The advice - to keep cases here for management to contact the infection.
We also visited the dispensary itself - which was actually fairly well stocked and not busy at present. One problem - poor communication with the district hospital at Pangani. No phones or faxes - the staff just use their own mobiles at their own expense - which is a deterrent given the cost of calls here.
I am exceedingly hot and tired after just three hours in sun.
Ps did you notice the mosquito net placed next to a fishing net? Sadly the district medical officer (the only doctor at Pangani hospital) also reiterated that out of all the nets he'd distributed, for free, not a single one was in use (at least, for the purpose for which it was intended). He also explained how local beliefs prevailed and that people thought that both vaccination programs and impregnated mosquito nets were a ploy by the government to render the population impotent and infertile.
Sunday, 9 October 2011
The hospital with no supplies
It's depressing.
Our rural project. Pangani district hospital. Everyone says the same thing.
If you've got HIV you're one of the lucky ones cos at least you're getting some drugs thanks to the international community.
But if you've got a simple chest infection - the pharmacy is all but
Empty. And oxygen? You must be joking.
My remit is to perform a health needs assessment and then write a business case for external funding for the hospital.
The problem is that we only have 4.5 days and most of the issues people have highlighted are slightly beyond us.
"we have no supplies- no drugs - no petrol for our vehicles"
"all our staff leave - and 80% of our posts are vacant"
Our rural project. Pangani district hospital. Everyone says the same thing.
If you've got HIV you're one of the lucky ones cos at least you're getting some drugs thanks to the international community.
But if you've got a simple chest infection - the pharmacy is all but
Empty. And oxygen? You must be joking.
My remit is to perform a health needs assessment and then write a business case for external funding for the hospital.
The problem is that we only have 4.5 days and most of the issues people have highlighted are slightly beyond us.
"we have no supplies- no drugs - no petrol for our vehicles"
"all our staff leave - and 80% of our posts are vacant"
Plus ca change
On our way back we are told that there is a 36/40 pregnant woman who needs to be transferred over. We pick her up at another dispensary then take her to the health centre, who carry on to Pangani.
I'm struggling at present though with the task I've been given. Writing a needs assessment is easier when you have queues of patients and full wards. But here at the health centre only one bed out of ten is occupied. There is little activity after midday. It was similar at the first dispensary. And they all have the same complaint - people present too late because of distrust of western medicine and a preference for traditional healers.
I speak to my Tanzanian colleague about this.
He tells me it is a difficult situation because most of the public don't trust the hospital
I'm struggling at present though with the task I've been given. Writing a needs assessment is easier when you have queues of patients and full wards. But here at the health centre only one bed out of ten is occupied. There is little activity after midday. It was similar at the first dispensary. And they all have the same complaint - people present too late because of distrust of western medicine and a preference for traditional healers.
I speak to my Tanzanian colleague about this.
He tells me it is a difficult situation because most of the public don't trust the hospital
Sisal
The export crop that is tanzania's main export. It is hated by many because whilst it creates jobs for unskilled labourers, it feeds no one. Similar to coffee.
We see it everywhere here but at the same time we have people living on less than 30p a day, unable to give a decent meal to their families.
We see it everywhere here but at the same time we have people living on less than 30p a day, unable to give a decent meal to their families.
Pangani
How to summarise yesterday and today ...
1) a very long a bumpy journey
2) getting stuck in mud and having to push the bus out
3) a lovely house by the sea
4) a visit to the tanga yacht club
1) a very long a bumpy journey
2) getting stuck in mud and having to push the bus out
3) a lovely house by the sea
4) a visit to the tanga yacht club
Shake it like a Polaroid picture
Has become the anthem of our bus given how we all lose a filling / prosthetic hip joint every time we get in, due to the vibrations!
Useful fact for the day
1) an LMA ( laryngeal mask ) can easily double as an effective "She-wee". I'm told.
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