Thursday, April 24, 2014

Day 21: Turn out the lights...

Day 21: April 24, 2014


Welp, turn out the lights, folks...this party is OVER!  Fortunately the one at home, though more familiar, is much more fun:-).


The day started with my attempting to make myself miss daily Mass at the Cathedral for the last possible time I could attend.  I hit the snooze on my phone semi-consciously, at best.  The second time around I was kind of aware of it and fought off sleep to get to Mass.  Again, by the time I had everything ready, including myself, it was about 5 minutes until 6:45.  I did my best to hoof it over to the Cathedral, ignoring any concern that I might become the sweatest and smelliest person in the Cathedral. I made pretty good time, i thought, but the fact that I had left the house the latest that I had all week couldn't be undone.  I walked up the side aisle of the Cathedral to what had become my usual spot as the "Gloria" was being said.  Using the now beneficial fact that Swahili takes almost twice as long as English, typically, I put down my backpack, made the Sign of the Cross, and started going through what I had missed (The opening prayer, the Confiteor, the Gloria).  By the time the sister at the ambo was halfway through the first reading from Acts, I was caught up.  Gotta love Swahili (when it's not leading to a 3 hour Good Friday service, at least).


I'm not sure why, but Mass today was much more solemn and what I'd expect out of a daily Mass in the States.  The parts of the Mass that were sung were done so very simply in tunes known to the congregation and not just a select few or, heaven forbid, the cantor only. The Sanctus was very simple and short, the Agnus Dei was in Latin and to the tune that I'm sure most would recognize, and the Great Amen was actually just an "Amen."


When the time just before communion came, it became apparent that the priest was doing something a bit different than normal as it was taking him minutes and not just moments to prepare.  He was fiddling around with something on the altar, and then finally began to carry one of the Consecrated Hosts over to the tabernacle.  Now, I'm not sure if I've mentioned this, but I'm fairly certain that the front/facade of the tabernacle is removable and doubles as a monstrance...if you look at the pictures I've posted before you can kinda see that. When the priest went over to collect the previously Consecrated Hosts, he placed the one he carried over from the altar into the monstrance without actually removing the monstrance.  So essentially we had a tabernacle with Jesus's Body there for all to see as if for Eucharistic Adoration or Benediction...I kind of like to think of it as Jesus kinda peeking out the window and saying "Howdy."


Anyhoo, after this, the remainder of Mass proceeded as you would expect.  Following the final blessing (yes, really the final one for me!), the priest processed out just as he would for any normal Mass, leaving the Blessed Sacrament exposed at the side altar in the tabernacle/monstrance hybrid.  I imagine that the nuns who attend daily Mass regularly were keeping watch until Adoration ended (as they were still there after I stopped for a few moments to say hello again and to ask for the blessing of a safe trip home).  After my short prayers, I knelt down on the ground and threw any germ-minded caution to the wind, bending forward with my knees on the ground and my forearms on the ground as well (as I would leave adoration typically in the States).  I told Jesus I'd see Him on the other side, and then headed out of the Cathedral for the last time.  


On my way over to clinic, of course I made my usual quick pit stop for a Fanta, and then through the yellow gate leading onto the hospital grounds, past the Wardi's and to Baylor COE Mbeya for the last time.  We had  our usual Thursday morning meeting, and then I checked up on my flights, checked some emails, read through my last HIV lectures for the month, and threw up a couple journal entries before the first patients were finally ready to be seen (which, as triage really didn't start until 9 AM today, meant about 9:30 or so...Tanzanians are seldom if ever rushed).


The morning was a good one, and I was able to see more patients before lunch than any previous day.  Granted, the fact that about three of them were HIV exposed infants (who don't require that much time typically) helped move that total up, but still.  There were some uneventful follow-up patients, a couple sick kiddos who probably had a viral illness but of course got a course of amoxicillin, and then my exposed babies, all of whom are negative thsu far (thank God).  Really kinda before I knew it it was time for lunch...which I figured out when my tranlators couldn't be found (rather than hearing from them that they were breaking for lunch).


I had to return to Vic's to get my Chips Mayai fix, of course...I love that stuff! I mean, it's eggs, it's potatoes, it's salsa, and it's meat.  If only they had some cheese it'd be just about perfect...though come to think of it, until now I never really noticed not having cheese.  As I didn't stock my wallet this morning, I only had about TZS 4000, so I figured that I'd pass on the meat today to be sure I could pay for what I ordered.  Very kindly, though, one of the clinic workers there told me I could order a smaller amount of meat for less, and that sounded pretty great to me.  About ten minutes later, after watching the nice cook prepare the food, i was off back to the COE to eat lunch while checking some emails and house-related things.  The meat was actually much less tough and connective tissue-y today, and the fact that I actually had something to drink to go with my salty food made it even better.  I finished my meal quite contently, and then headed back downstairs for a short second half of the day.


When I arrived at the reception desk, the pile of files was rather low, so I grabbed a file.  There was a second one stuck inside it, so I corrected the mistake (or so I thought), and headed back to the room.  We called the patient and to my surprise, two patients and an adult walked back.  It turned out that the mama and daughter came for their scheduled appointment and brought their niece/cousin to be tested for HIV.  She unfortunately turned out to be positive.  So, what I figured would be my last patient, nice and simple, turned into TWO patients: one with somewhat poor adherence and feeling sick, and the other with one month of fever, boils on her scalp, recurrent ear infections, exposure to TB that had been treated and was currently being treated in her cousin and auntie (respectively, and a new diagnosis of HIV.  


It turned out to be a rather appropriate final encounter.  First, it allowed me to see an established patient who was having problems and attempt to correct them.  Second, it allowed me to interact with a family in the setting of a new diagnosis (though fortunately, ina  sense, this was easier on me than it would have been as mama already knew the drill from treating her daughter).    Last, it made me realize that there was still a lot for me to learn, which was good as I was feeling like I was getting into the swing of things.  It was both humbling and motivating, reminding me that no matter how comfortable I get seeing things I think I know, I always have room to learn more and more.  


Fortunately, I had the guidance of Jason, who was willing to help me out with a situation I had not yet encountered.  I wanted to 1) Treat this kid with antibiotics for her infections, 2) Test her for TB, 3) get her started on treatment asap, and 4) do it all now!  Jason talked me through her case and through the fact that though she had a lot of exposures and potential risk factors, that she actually didn't appear terribly sick.  With his help, with decided to treat her current skin and ear infections (which would also cover any potential pneumonia), start her on prophylaxis for TB and other HIV associated infections, get some baseline labs, and see her in a week for likely initiation of treatment for HIV.  When he put it all together, it all made sense, and the adage "Practice makes perfect" rang true.  I still had a long way to go.


Oh, and to make the month complete, as it never is until you see it, mom dropped an "Oh by the way," as we were finishing up: turned out she had an itchy rash that within 5 seconds of seeing it (and NOT touching it) cause Jason and I to both say "Scabies."  My month was thus appropriate, I thought.


After finally finishing, the stack was empty, as was the waiting room, and the day was over.  It was after four, and I called home for the FINAL time from Mbeya.  Everything was going well, and Ali and the kiddos were getting ready to go to Ali's Bible study.  After getting to say hello to all of the kiddos, and getting to look up Jude's nose and at the ceiling as he tried to hold the phone to talk to me, it was time for them to go, and I told them I would actually SEE them on Saturday.  We were all so excited that we did our silly dances! (Okay, maybe it was just me and the kiddos just watched and laughed, but still).  


I finished posting all of the journal days I could before wrapping things up for good.  I turned in my office key, my books, and my evaluation forms.  I took a picture of the office, turned off the light, and told Jason thank you and goodbye.


Jason and Liane went above and beyond to help take care of me while I was sick, and I told him how much I appreciated it.  When you start to get sick in a country that you've never been to, your mind starts to wonder and worry, and you begin thinking about how the last place you'd ever want to be is in a hospital in a smaller city in a third world country.  I had taken myself to that place in my mind when my horrible chiils wouldn't stop and I felt like I'd never get better...and he and Liane helped immensely by doing what they could to keep me well.  Now, was I really near needing the hospital?? I'm pretty sure Jason and Liane would tell you not.  However, in my mind, I was already there, and I was terrified.  Their help was priceless.


I took a few pictures of the clinic as I walked out, then a few outside in front of the sign, and then headed back to the house.  I passed the Cathedral for the last time, stopped at the small grotto with the statue of Mary, and then proceeded down the main road, passed the roundabout and up the hill that would eventually turn down and into Mbeya Hotel.  I passed the four or five ATMs that wouldn't take my American Express card a couple weeks prior, I passed the rows of locals set up on the ground on the side of the road selling clothing, shoes, dishes, fruits that they set out each morning and packed up each evening.  I passed the stalls of small shops that flanked the soccer stadium and the DSTV store where a large crowd had gathered to watch a soccer match on their one small TV.  Finally, I came to Mbeya Hotel, where I had arrived three weeks before and couldn't find Jason and Liane (mostly because I hadn't looked well enough), leading to my walking up the hill with two suitcases to check my email on the free wifi at the Hillview Hotel to be sure I was in the right place.  Before heading home, I checked to ensure there were no volleyball players on the court, and after confirming as such stopped one last time at the ATM to get myself a load of shillings to pay my rent and buy some souvenirs.  Then it was one last walk down the road the house was on, with the mountain I had climbed transitioning from golden to silhouetted in the setting Rift Valley sunlight.  As I reached the house, rain of course started to fall, and I rushed inside before a rather heavy shower set in a bit later.  


At the house, I set to finishing up with souvenirs and settling up wth rent.  Then the siblings who had hosted me for three weeks headed off to their weekly Bible study, while I stayed home strategizing how to fit everything into my suitcases.  It took a while, but I got all of the clean clothes and souvenirs into one suitcase, and all the dirty/smelly clothes and my shoes into another.  It was really a small miracle.  After finishing up packing (for the most part), I sat on the veranda in the dark and Yuppy kept me company as I prayed Vespers aloud (the benefits of being alone in the house) and enjoyed the dark, quite Valley whose presence in the distance was only revealed by a relatively small number of twinkling city lights.  Then I set to getting some food, eating my samll amount of remaining nutella and peanut butter and cautiously eating one of the leftover pieces of pizza that Carmelle left behind from last Thursday...only a week, it's still good?? Right?? Right??


 And essentially, that's all she wrote folks.  I'm journaling now, and between now and when I leave all that will occur will be some sleeping, some showering, and some final that I added a couple more things to my souvenir list I have a small challenge to fit the new things worries...I've adapted to changes and challenges over the past few weeks, and I'm sure my suitcases can do the same.

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