Thursday, April 10, 2014

Day 6 Sick, and Tired of this Crap

 April 9, 2014:

Day 6 began much like the previous had ended...more time battling what I was presuming was ETEC (look it up).  Which of the many foods from previous days were to blame I hadn't a clue, or perhaps it was the local water (which was "filtered"...though I'm not sure what that exactly means).  I was getting pretty tired of it.

The benefit of waking up a number of times this morning was that I actually woke for a purpose around the time my alarm went I was up and getting ready at 6:30.  I was all dressed and cleaned up for clinic by 7 and had some time to make my toast and eat it at home.  This time, however, I had some homemade bread from a local resident in town who our housemates knew, and it cost only 1600 TZS for the dollar for home-baked bread!  It was delicious.

We walked to clinic along the same path as the previous day with nothing out of the ordinary other than my noticing a small white object in the distance up on the mountaintop that I hadn't noticed before.  It stood out because the rising sun was hitting it directly this morning, and I asked Carmelle what it was.  She remarked that it was a cross placed up there by locals.  I made it a silent mission to hike up there sometime during Holy Week, though as the cross was much higher elevation and maybe 2 miles in the distance, I instantly wondered if I'd actually be able to do that...not in my current state of dehydrated health, most likely.

This time, we arrived at the clinic and stayed there to see patients that day.  Liane, one of the BIPAI docs who had been there for 2.5 years with her husband, Jason, both of whom me at the Mbeya Hotel on the day of my arrival, brought me a binder called a "Clinic Aide"...essentially a how-to for clinic survival.  Earlier that week, Carmelle had mentioned that when she started, she said she shadowed "Once or twice" or for "one or two" before they had her see patients on her own.  I assumed that this meant one or two DAYS.  But no no, after a brief run through of the binder, and a glimpse at the EMR, I found out they meant one or two PATIENTS.  I instantly felt underprepared and overwhelmed.  

Liane and I saw one patient together, and though fast and requiring multiple steps, she made things seem easy enough...but she'd been doing this for 2 years. After the first patient, she asked if I wanted to start on my own or see another patient with her.  "Umm, let's do one more," I said. Of course, I would have preferred a few more, but that didn't seem to be an option. After the second patient, Liane found a room for me to work in, introduced me to Maggie, one of the Swahili interpreters, and I was on my own!

I cycled through the process throughout the day...grabbed a chart from the front, retreated to my room, looked through the EMR at the previous visits and last visit note's plan.  I quickly flipped through my 2-ring binder, which kept trying to open on it's own and spill all the laminated contents everywhere, searching for the right drug doses, the protocols for each kid, etc.  My patients ranged from HIV exposed infants on prophylaxis to kiddos on antiretroviral therapy with tuberculosis prophylaxis to a mother of a patient who happened to have fever and sore throat (for whom I wrote a script for amoxicillin, after hesitating on whether or not I was actually supposed to "see" patients.

Now of course, this wasn't a super-resource limited evidenced by the nice rooms, electronic medical record (EMR), and availability of more than one HIV treatment regimen.  This wasn't the Mbeya Referral Hospital Wadi.  Also, though I was seeing patients on my own, Liane, Jason, and the other doctors were there for me to sign patients out to and to correct any errors/add any additional studies or treatments as needed.  So, it wasn't as bad as dropping me in a pool and telling me to swim without some "floaties".

The day progressed, and with it the rain came. However, today, rather than the rain coming, raining for a short while heavily, and then clouds dispersing, the rain was essentially constant.  From about 11 AM to probably 3 or so the rain fell, and steadily.  No breaks with just a slight drizzle or mist.  Heavier at some times than others, yes, but constant nonetheless.  Thus, my plans to run into town during lunchtime were changed to just taking a lunch break to do some work while Maggie met with other local workers in the break room for her lunch.

The afternoon was similar to the morning, but I saw only a couple patients as I spent part of the afternoon with further encounters of the ETEC kind.  One patient, a break, and then another, and clinic was over.  I came upstairs to check some emails and do some journaling. About 4 o'clock Jason came to give us a lecture on antiretroviral therapies, first and second line treatment available in Tanzania, and their most common and most dangerous side effects.  It was most welcome (or Karibu-sana), as I needed a refresher, especially since the number of pediatric HIV patients I had cared for since Botswana could be counted on one hand.

After lecture, I called home again and was happy to see that Ali and the kids looked a bit less stressed.  Mary-Teresa looked much better, was smiling, and was letting Ali actually put her down!  I also was able to diagnose Jude with hand, foot, and mouth via telemedicine (though if you've never tried looking for erythematous blisters in a childs mouth via a Google+ hangout from Tanzania to America, I don't recommend it as the resolution kind of makes it difficult to see anything...not even taking into account trying to coordinate a phone in one hand, a flashlight in the other, and a 2 year old who is less than perfectly cooperative.

Reassured that things were going better at home, I hung up (and there was no crying this time!) and made one last pit stop before making a daring venture into town.  My goal was to buy airtime for my phone, peanut butter for my breakfast/lunch, and possibly some cipro for my intestinal issue.  Before leaving I ran into Liane and asked her if there were any additional markets in town other than the one (Azra) that we had passed on a previous day. She mentioned that there was another around the corner called Babu Kubwa.  Then she threw in, "Azra is better for food, Babu Kubwa is better for alcohol."  Good to know...

I made my way toward town with my only bearings being that I knew Deluxe diner was down the hill  and east, and that Azra was along that road.  I made my way down streets that were familiar and passed shops that I had seen before at some point in the previous few days.  I walked down the street that led to Deluxe, but didn't see Azra anywhere.  That being the case, I went around a corner and down the hill just a bit more and stumbled upon Babu Kubwa.  

This "mini-market" was just that.  About 18 X 12 feet with one center stand and foods along the surrounding walls, with so little space between I was almost certain my backpack would knock over canned goods and bottles along the wall.  Certainly this was the place for liquor, if you wanted it. They had any commercial liquor you'd see advertised in the States, along with a few more regional ones.  I looked for a few minutes at the Amarula (if you don't remember my infatuation with Amarula, see my Botswana blog), but my wallet and my stomach just didn't seem too inclined...I know, I must have been sick!

I perused the selections for a while before finally deciding just to buy some Nutella...I wasn't particularly excited about the lone jar of peanut butter they had...and since I hadn't had lunch, I grabbed a plastiki (plastic) bottle of Diet Pepsi and a Twix!  I paid the Indian man who owned the shop and was on my way back up the hill. 

 The mountain Mbeya sits on

 A view down the hill toward "town"

The road Deluxe and Azra market sit on

Convinced I had missed Azra my first time down, I retraced my steps toward Deluxe and found that somehow I had just missed the sign for the other Indian-owned market within a kilometer of Babu Kubwa.  Indeed, this place had a bit better food selection (cheeses, meats, chips, multiple jars of peanut butter, etc). I almost bought some pasta and tomato sauce (thinking about making some Pasta a la Gaborone), but when I was shown the bottle of tomato sauce (which was actually catchup), I passed and just picked out a jar of peanut butter that clearly stated it had been manufactured in the United States.

As I paid for the jar, the Indian woman (who spoke English! Hooray!) said to me: "Thank you, sir.  Sir I would like to give you a compliment."  Now, the only thing I could imagine she meant was that she wanted to compliment me on something, and the only thing she had seen me do was walk through here store and buy peanut butter.  So, I thought maybe she meant I had picked a good jar of peanut butter.  

She quickly followed her first sentence with "Do you eat?", I thought his meant had I ever eaten my apparently excellent choice of peanut butter, to which I replied, "No."  She responded "Chips? You don't eat?"  

It was at this point in time that I noticed one of the Tanzanian store workers standing not 3 feet from me holding out a small bag of salt & vinegar Lays chips.  Suddently it all made sense.  She wanted to GIVE me a COMPLIMENTARY bag of go with my peanut butter?  I took it as her way of trying to elicit future business from the obvious foreigner.  I responded to her second question affirmatively, thanked her, and now had something to COMPLIMENT my late lunch.

A healthy meal indeed...Diet Pepsi, salt & vinegar potato chips, and Twix.  I walked back up the hill chomping on my chips and soda, saving the Twix for dessert.

Breakfast of champions

Along the way I stopped to purchase some airtime and subsequently added it to my phone in order to purchase some data.  Strangely, my "bundle" didn't have any listed minutes or texts as I navigated through the only menu for bundle ordering I could find...remember, I had been given a SIM card and sent out the door the day prior, told only to buy airtime on the street and with no further instruction. So I googled the network's website and found a code that I entered to buy a data "bundle". Of course, excited to have some internet connection on my phone, I scratched off the cards and entered my airtime codes right there on the street and added a 500 MB "bundle."  It turned out later that there wasn't much bundle about it.

As I finished putting in my airtime codes a man walked up to me along the road and motioned to me.  About 5 feet way, he stood there, silent, and held out his and toward me, then withdrawing it and putting it together with his other hand.  He was begging, I could clearly tell, but would not or could not say a word.  I looked at him and tried to politely say "No, I'm sorry." At first he just stood there, but after I repeated, he nodded toward me and walked away.  Honestly, I still don't know what the right thing to do in that situation would be, but just after I was a bit upset with myself that my immediate response was not one of pity and generosity but instead one of avoidance and refusal.

After this encounter, I felt less like spending time in the streets as the sun started was nearing the mountain.  I was standing outside the pharmacy (which, buy the way, will sell ANY medication to ANYONE without any prescription), but decided that I'd give my ETEC one more day before attacking it with cipro.  I continued my walk home. 

Along the path of the main road, I saw in the near distance what appeared to be a line of men standing outside one of the shop stalls.  I wondered what business or good was in such demand at 6:30 PM.  As I approached, it became clear that this wasn't a line, but a group of men crowded around a small TV in the DSTV shop watching a soccer match.  I found this rather entertaining, stood for a moment or two with them, and proceeded home.  

As I walked home taking pictures, this man along the road said to me, "What about me??" Eventually I figured out he wanted me to take his picture, so I did, and he was very happy about it.  He didn't even ask to see it!

Once I got home, I regretted my decision not to buy ETEC raged again.  Luckily for me, Carmelle offered me a course of Cipro that she had from a previous international trip, and I graciously accepted.  I swallowed that first pill and though, "Let's bomb the hell outta those little jerks."  Now, I've broken almost every rule that I tell my patients to go by:
1) Never take another person's medications
2) Never take medication that's left over or old
3) Never treat yourself without seeing a doctor
Now, I've not broken rule #4, which is: Always finish your full course of antibiotics...and I have no intention of letting these little buggers get off easy by cutting short a three day course.

Immediately I felt better, not physiologically, but because I knew I was doing something about it.  As I hadn't had a proper meal that day, we decided to run down to Mbeya hotel and order some food to go. Now, this went much fast, as we walked in, directly told a waiter we wanted food "for carry away" and placed our order.  I downed a ginger soda while we waited to help settle my stomach (at least that's what Gigi always said), and we walked out with our food a few minutes later.

At home, I downed my chicken and noodles hungrily, again not even thinking about keeping leftovers for lunch.  As far as I was concerned, things were going straight through, so I had no concern for caloric intake.  I finished up and pulled out my computer to try to catch up on some journaling.  

As I was finishing up, Josh asked me about my phone which I responded about how I only saw the data and didn't see how many minutes there were on the phone with it.  He came over and showed me a DIFFERENT code that he used to get to a DIFFERENT menu, which had bundles of minutes, data, and texts. Now, the disconcerting thing was that these bundles had minutes, texts, and data for CHEAPER than I had paid for my previous "bundle" of data alone.  I was rather frustrated...but knew it wasn't that big of a deal after all.  

However, not long after that, Amelia approached me and told me that the 3 $100 bills I had given her for rent earlier that day were not accepted by the, apparently, in Tanzania $100 bills from 2006 and before are not accepted...despite the fact that they 1) have a watermark, 2) have a security strip, 3) have multiple other features that prove them to be real, and 4) ARE ACCEPTED IN A FIRST WORLD COUNTRY aka THE USA.  Now I was frustrated because of but not with two of the siblings I was living with. So much for the almighty currency wasn't current, see?? I ended the day feeling like I couldn't do much right again...

...however this time I was able to let it go a bit easier, as I knew I was getting a handle on things in Tanzania and could overcome little obstacles here and there.  It didn't make things just fine, but less frustrating and more peaceful.

I ended my day with some evening prayer, and fell asleep before I could say my daily Rosary.  After all was said and done, I was sick...and tired of this crap...however, I had already started to take action against the literal meaning of the word, and was confident I could take care of the figurative in the days to come.


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  3. wait wait wait! if you said you got a diet pepsi, then why is there an empty bottle of coke zero!?