Clinic Day 3

Fridays are half days here in Arusha for religious reasons, so clinic today was from 9am to 1pm. As usual, I left my guesthouse around 7am and arrived at 7:30am. As I walked up, I saw some people cleaning who I didn’t recognize (usually the receptionists are the ones who mop the floors in the morning between 7 and 9am). We got into conversation and it turned out that they were theology students at the University of Arusha and as part of their work study program, they spend Friday mornings helping clean the clinic in the morning. It was pretty cool to talk with them – they asked interesting questions about life in America (e.g. why do people have only 1 or 2 kids?) and then they asked me to come pray with them. Now this is something that I’ve thought a lot about: as a future physician, I know that I will have patients who ask me to pray for them, with them, etc. What’s the right response to that if I do not share their belief system?

I responded and said that I would come stand with them as they prayed, which seemed like a good compromise and they seemed satisfied. They went into the overnight ward room where the baby with pneumonia was recovering and prayed for her. At one point they said something to the effect of “and we pray for the American doctor…” and I looked around for this other American (!!!!) only to realize they were talking about me. Ha, definitely not a doctor yet guys! Anyway, it was a really beautiful way to start the morning and although they were so confused about where I would go to church this afternoon, it was fun to talk to them until clinic got officially started.

In the mornings, the temperature here in Arusha is probably in the 50s/60s, which feels like a breezy fall morning to me. I don’t know if you’ve noticed from the pictures, but people here bundle up because it’s technically winter for them so they consider it to be so cold! Appropriately, patients trickle in very slowly early in the day and once it gets warmer, there’s a huge number of them. So our clinic day Friday started really slowly. At one point, there were no more patients, so I went to go see what else I could do (I hate sitting idly). I found Roda, one of the nurses, in the pharmacy room taking inventory so I ended up helping her for a couple of hours. Granted, I missed out on seeing the majority of patients today, but I actually didn’t mind because I learned about the drugs they use, where they’re imported from (Kenya, India, Europe), and I actually got to complete a task – something I miss when I see patients here because there’s no following up on patients. I tend to want to check in with patients, so I can confidently close that metaphorical book so it feels like I’m leaving things halfway done when I see a patient, diagnose and prescribe them something and then never see them again. So taking a full inventory of the drugs at the clinic was actually refreshing because I could actually “close the book” at the end. I also think it’s valuable to see the behind-the-scenes work that happens here. It’s something that is so rarely thought about in America, but since this is a one-stop shop, I have the opportunity to really see what all it takes to be a successful healthcare organization.

This lady carried that whole bucket on her head WITH NO HANDS. There’s gotta be 50 or so bananas in there! Amazing. The nurse in the picture is Tedi, who also takes the employee shuttle with me. 

Dr. Koshuma buying some bananas!

Anyway, clinic was a short day and I went home, napped, ate, and fell asleep. Pretty uneventful, but I was gearing up for a busy day in town with Saumu the next day!

What surprised you today? Again, inventory was all paper-based and it was astonishing to think about how much time/resources were spent keeping track of inventory. It seemed inefficient and I caught myself daydreaming about how much would change at the clinic if they had 1 or 2 computers to work with.

What touched you today? Seeing the students pray for the baby with pneumonia was a really special moment. They were also just so friendly to me and inquisitive about my culture (apparently Americans are cultured to the rest of the world), so it was a fun way to start the day.

What inspired you today? There was a patient who was diagnosed with viral intestinal infection (her stool had a high number of leukocytes, but normal neutrophils), but she wanted to get her medications elsewhere. So Dr. Koshuma wrote her a prescription and she went. When she got to the other pharmacy, the person there said that it was an incorrect prescription (he said she should have been given antibiotics) and so she came back to argue it with Dr. Koshuma. Now I know that a normal number of neutrophils = not bacterial infection = antibiotics will not help, but seeing Dr. Koshuma talk to this patient firmly and taking the time to talk with her instead of taking the easy way out (just writing a prescription for whatever she wanted) was really inspirational.



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