Outreached

Outreach

The girls are shopping, and so I am spending my Saturday afternoon typing in my usual Moshi café (not seen a starbucks yet – no free refills) sunning myself in the garden with a big mug of Kilimanjaro coffee. I’m a big fan of Kilimanjaro-brand anything (water, coffee, beer and any product aimed at dim tourists) since yesterday evening as the sun was setting, for the first time in three weeks, the clouds parted in Machame and we saw the hill from the hospital. It really is an unreasonably big hill and it is hard to believe that the whole of its spectacular bulk has managed to stay hidden from view all this time. I am taking its appearance to be a sign that the rainy season has finally ended and so the next weeks will be all sunshine and happiness.

Anyway, I’d planned to spend this time writing a little about the outreach trip Mary and I went on this Thursday, so here goes. The outreach team consists of a nurse, pharmacist and a clinical officer, and perhaps most essential, a big sturdy 4x4 and sturdier driver. Every Thursday the team visit a different village to run a drop-in clinic, providing some basic medical care to people who find it difficult to travel the long distance to hospital. Dressed in our white coats, which give us an undeserved air of legitimacy and authority, we bundled into the car and were driven down the mountain and some 30km, past a sugar plantation, to a village on the river. Of course the dirt roads were very Tanzanian so it felt like a good deal further. Our arrival at the village was a big event and we were instantly made extremely welcome at the church that we took over for the day – I was shocked to learn that the appearance of a medical team at this village happens less frequently than once a year.

Shortly after arriving we all sat down at a table outside and were unexpectedly served a breakfast of boiled sweet potatoes and sweet tea prepared by some of the local women. Once again we were made to feel tremendously and awkwardly VIP, as the pastor and locals all warmly shook our hands, brought us bottled water and made sure we had enough to eat and drink, despite having very little in the way of common language. After prayers, introductions and more prayers a consulting area was set up in the church and the pharmacist neatly arranged the contents of his box of meds on the table.

Mary and I sat with the clinical officer, Oswald. I can’t remember if I have defined clinical officer yet; they’re a bit like UK junior doctors. COs study clinical medicine(in English) for only three years and are awarded a diploma, but can specialise afterwards, or go on to further training: assistant medical officer is the next level and this allows one to use the Dr title. Machame hospital is also a clinical officer school that trains these enthusiastic students; about 180 over the three years and so they outnumber the patients.

We saw about 30 patients, a small number given the size of the village and infrequency of visits. Like at a GP surgery in the UK most of the patients were women, there were quite a few children and a lot of cases of hypertension (usually well over 200mmHg, I began to think of 160 as a healthy value). Treatment options are a bit simpler since the pharmacist only had a small selection of medications, so for example everyone with high blood pressure was given furosemide and, curiously, diazepam. (Where available in Tanzania first line treatment should be a calcium channel blocker, in line with UK NICE guidelines for black patients). As usual I was embarrassed by my lack of local language, but thanks to Oswald’s kind and comprehensive translations Mary and I were quite involved with the history taking, occasional examination and the formation of management plans. There was of course a complete absence of laboratory tests, so ultimately almost any symptom was treated under the presumptive diagnosis of UTI and/or malaria and/or gastroenteritis, for which the treatment offered consisted of both of the only two antibiotics available and some paracetamol.

After we saw the last patient (a gentleman with cirrhosis of the liver, probably due to viral infection but exacerbated by alcohol) we had a delicious late lunch of rice beef and bananas, another example where we have been genuinely and deeply humbled by the repeated generosity, hospitality and dignity of the people here in Tanzania, who often – as was definitely the case at this village – are very poor indeed, apologies for the sentimental cliché. 

some chump and a box of drugs in a landcruiser