I used the University of Arusha’s shuttle bus (more like van) to get to the clinic, which sits right inside the university gates. I was the first to get picked up on Day 1, so I assumed we were going straight to the university – personal driver for me, whoo! There’s a sign on the road that says University of Arusha and points to the turn you’re supposed to make, so imagine my surprise as we sped past this sign. Keep in mind that it’s just me in the back with my freshly cleaned white coat and all my valuables with me in my bookbag and there are 2 Swahili-speaking men talking amongst themselves in the front. I started to panic as they went past the turn and every news story about tourists getting kidnapped popped into my head. Lo and behold, this bus is an employee shuttle and I am not special by any means. We picked up about 4 more people and then headed up the mountain to the university. Now that I’ve figured out the whole shuttle situation (sharp learning curve), I must say it is incredibly convenient – thanks to the University of Arusha for the transportation! 🙂
So whew, first panic attack out of the way. I hopped out of the car around 7:30am and walked into the clinic. There was no one there. Cue panic attack #2. I sat awkwardly in one of the chairs and hoped I was in the right spot and that they knew I was coming. I was approached by 2 women, who asked “Who are you?” to which I responded with an open mouth and no words. Eventually, I figured out how to tell them that I was a medical student working in the clinic and they nodded appreciatively and told me to “sit and wait”. So I did just that, thankful that I had brought my Kindle along with me (it has really saved me on this trip so far). Long story short, I felt more and more awkward as nurses and other employees showed up and stared at me, telling me to sit and wait, sit and wait. The only questions running through my mind was, “What am I waiting for and how long because this white plastic chair is getting uncomfortable?” To everyone who knows me, please appreciate the uncharacteristic amount of patience it took me to “sit and wait” without knowing what was going on.
Anyway, over the next hour or so, the nurses all talked among themselves and figured out what/who I was and they warmed up quickly! One of them, Gladys, showed me around the clinic. I was surprised to see that this was a one-stop shop for healthcare – they had outpatient clinic, a laboratory, a pharmacy, a mini surgical center, a labor and delivery room, and wards for overnight care. It was also less industrialized than I anticipated – I knew I would be working in a low resource facility, but it was not quite what I thought it would be.
Reception area – notice the files behind (there are 4 more stacks under those: the entire clinic is paper based with no electronic medical records)
The delivery room – see the incubator for a newborn?
Dispensary – patients come here after seeing the doctor and get the prescribed medications from a nurse
Overnight ward space
Dr. Koshuma, the sole physician for the clinic, arrived at 9am and took me to his office where we discussed what I was hoping to get out of the experience and what I am interested in. Then, we started seeing patients! Medicine here is so different than what I am used to – first, the doctor sits in his office and the patients come in one-by-one. It’s also not really a full history and physical. He just asks them what the problem is (ex. cough), a few other related symptoms (ex. runny nose, headache), and either takes their temperature using an old school thermometer (that doesn’t get cleaned between patients), auscultates the chest, or palpates the abdomen. Then, he sends a blood smear, urine test, or stool test to diagnose – no Xray, CT, MRI, or ultrasound. There’s minimal bloodwork as well – really just a parasite check (malaria, Giardia, etc.), hemoglobin (no differentation of iron deficiency anemia, etc.), or CBC with diff (just high neutrophils). Essentially, it’s what you can see under a microscope and that’s it. It’s hard to wrap my head around because we’ve been taught using relatively new technology to diagnose and treat, but I forgot that there were ways to practice perfectly good medicine beforehand. For example, instead of using an ophthalmoloscope/otoscope to look at palate elevation and the throat, he sits the patient down in a chair and directs them towards the window, using the sun’s natural light. Honestly, it works better than what we do.
Patients on day 1 mostly presented with flu-like symptoms, although there were some interesting cases. First, a patient came in with a gaping wound following the line of his sternocleidomastoid. I watched Dr. Koshuma stitch him up, but the whole time I was thinking “omg, carotid sheath, omg, carotid sheath)” – Dr. Kernick would be so proud. Anyway, Dr. Koshuma is a big believer in “see one, do one, teach one”, so he said I can do the next one! Fingers crossed it’s not close to such important vasculature so I won’t be quite as nervous about messing up. Interesting case #2 was a man who came in with multiple days of diarrhea, although he said he had urgency but not much came out when he tried to go to the bathroom. This was all the history that we got – we sent him to do a stool test and it came back positive for Giardia! Rx: metronidazole and he was well on his way.
I took a late lunch (~1:45) at the university cafeteria. It cost me 2000 shillings, which is less than $1. But, I wanted a small treat after a long morning so I got a little mango juicebox which costs 1200 shillings…definitely will not be doing that again. My day ended pretty interestingly. Dr. Koshuma left to go eat lunch around 3pm, but there were still patients that needed to be seen! I was relaxing with some other nurses outside when one nurse called me. Thinking she needed help, I followed and promptly got sat down across a patient and was expected to listen, diagnose, and treat him. Obviously, I am so not capable of doing that but it took her some time to really believe me. I told her I had no idea, so she said,”okay just write down these drugs for him so he can go”. Again, I had to tell her that I couldn’t just prescribe people drugs, especially since I had no idea what his problem was and I have no basis to write drugs anyway. She looked a little frustrated, so she just wrote the drugs down and he went on his way – hopefully they were the right ones…?
So my day ended not so great – I was tired, I didn’t learn a whole lot from the patients/staff there, and I just felt so out of place and useless. Everyone spoke Swahili, even if they knew English, so half the time I just stood and listened to words I didn’t understand. I went home feeling discouraged – was this how it would be for 6 more weeks?
These 3 questions are mainly for days like today:
What surprised you today? So many things surprised me, but mostly how different medicine even on the same planet. I kept picturing UNC’s gleaming white hallways and stocked patient rooms when I was at the clinic and it really made me realize that what we consider to be normal is so extravagant.
What touched you today? Dr. Koshuma saw a little family – a women and her two little boys. After he saw them in a doctor-patient role, he took the two little boys out to his car and started the car to their immense enjoyment. I’m not sure why they thought it was so interesting, but it was really beautiful to see a doctor step outside of his professional role to just have fun with the kids.
What inspired you today? Ah, this one is hard. I felt pretty beaten down after my day, so the only thing that was inspiring was that it would surely get better as I got more acquainted with the clinic and the people there. I mean with 6 weeks left, it has to get better right?