Day 1 Brain Dump!

Takeaways from today, our first full day in Ilula and first day at the hospital.

1. the house we're staying in feels homey like in a lake cabin or church camp way. 

2. It's pretty clear we are travelers here and stand out from the crowd but everyone is so welcoming and just as excited to meet us as we are to meet them. Someone says karibu and smiles every time we walk into a room or new space. They're patient with the language barrier and keep teaching us Swahili and HeHe. 

3. Two memorable patients we saw on rounds in the general ward with Dr. Gloria were: 

•  a 60-yr-old male with recent convulsions currently comatose. They diagnosed neurosyphilis and neurocysticercosis at a regional hospital. Also likely had a DVT in left leg due to unilateral swelling and several weeks of immobility. Unfortunately, don't have diagnostic tools or heparin or other anti-thrombolytics available to treat it. 
• a 33 yr-old male w/ hx of Hep B on Truvada had cirrhosis, ascites, and portal vein HTN. Paracentesis was done and started on furosemide and spironolactone. Direutics were increased today but financial issues are a big concern so further management steps are questionable.

4. After rounds and lunch John, Solveig, and I ended up talking about the ethics of our trip and the good & bad impacts of global medical care - so much a little topic clearly. I had thought about this a fair bit in prep for the trip. Is this a self-serving trip? Are we doing harm by visiting for a few weeks then leaving for the year? How can we be culturally appropriate and conscious while here? What is charity vs justice? empathy vs pity? guilt vs beneficence? 

We didn't exactly land on a solid conclusion and solve all the world's problems (yet) but the rationalization I've come to so far is:

• This group/trip is here very graciously and to learn from the Tanzanians. Not just medicine but all aspects of life. Despite some of the very stressful and difficult situations they are facing, everyone here seems happy. They have their friends and family, they laugh and smile a lot, praise God and sign hymns with their whole hearts, and they are kind. It's so easy to think "these poor African people" and while they have major  systemic public health needs, they're rich in many ways too. And I'm sure many people look at the USA and think "those poor Americans" too. 
• Historically, they don't come here and say "here this is for you" instead they ask "what can we do for you? How can we help?". The help offered is intentional and thoughtful. 
• The heart of the trip is to build and maintain relationships with the staff in Ilula. I don't think that's ever the wrong place to start.
• Most of the patients we will never see again. We won't remember their names and they don't know us. But they are going through sickness and we get to bear witness to that. We get to hear their stories, see them, and know them. No one here takes that lightly and I hope they feel seen and less alone even if it was briefly. 

At the end of this long post, I still really don't know! But I'm jet-lagged, sleep deprived, and so green to the US medical field and being a provider let alone Tanzanian medicine so maybe it's not supposed to make sense right now. Fortunately, I have 3 more weeks here and decades as a PA to keep learning and figuring it out! :) 

Jaci