Thursday, 2 February 2012

On strikes, stomach complaints and mountain hikes

Again I am sorry for the lack of blogs lately.  Life seems to have been very hectic at work and at home.  There is a nationwide strike of all Tanzanian doctors and as from yesterday the nurses are also on strike.  The strike as far as I can gather is about pay.  It seems that the new interns have not been paid for their first 3 months work and the government are also wishing to reduce the payment for on-call, which as you can imagine is most unpopular.  When I talked to one of our Tanzanian residents today it seems that the doctors want a 150% pay rise!  With the advent of modern technology the strike is orchestrated by mobile phones and the doctors are informed of whether they should attend work or not by text message. We find it quite confusing in the RDTC as all the residents turn up for their 8am teaching lecture and then many seem to disappear before clinic or the ward round! (Doctors Strike news)

It is very difficult for patients at this time.  We have a 23 year old lady on the surgical wards who has now been waiting for over a month for an operation to remove a large malignant tumour from her foot but now with the strike we have no idea when this will occur.  KCMC hospital is in a much better state than those hospitals in Dar es Salaam as we have many non-Tanzanian volunteer and permanent staff and in the Dermatology centre many of the residents are from all over East Africa.  However in Dar es Salaam it seems that people are dying as the hospitals have no medical or nursing staff which is terrible.  The strike has been ongoing for a week and no-one has any idea what will happen or when.  It is very difficult for those nurses that are working as they do not have input from the medical teams.

Patients have to pay for their inpatient stay (2500 per day which is just over £1) and this includes food.  We have one inpatient with pemphigus foliaceous – a blistering condition of the skin- who is much better but as he comes from a very poor village he stopped using his topical treatment when we discussed discharge as he did not want to go home.  Patients have to pay for all their investigations – x-rays, blood tests, scans etc.  What seems most unfair is that if the lab/ radiology department loses their films or results then the patient has to pay again for the investigation to be repeated. 

Another development this week is the government and university announcement that all Medical students that had not paid this years course fee were to be thrown out of the university.  So I was not surprised that none of the 20 4th year medical students were in the department yesterday as they were desperately trying to get their fees together.  We have the end of 4 week attachment exam for the students on Friday at 7.30am so as a department we have decided that all can take the exam whether they have paid their fees or not as otherwise they might have to repeat their whole attachment at a later date.

I'm soooo not a submarine!
Last week unfortunately Zac developed terrible constipation.  It is over 40 degrees here and he runs about so much at school and does not drink enough water.  As he was so constipated he then developed an anal fissure (a small very painful tear in the bottom) which meant that he refused to poo as it was so painful and so his constipation became worse and worse.  We eventually had to give him an enema and I think I will leave it to your imagination how that went!

Friday was the primary swimming gala at school and so I took the morning off to see my boys swim.  Zac was fortunately better and so I took my place on the bench to proudly watch my boys.  Miss Lindsey Josh’s teacher came up to me with Josh in his swimming clothes and a towel to tell me that Josh had vomited as soon as he had reached school that morning!  I suggested that he should not swim then and she gave me a withering look and said “ he is only wearing his swimming gear as he vomited over all of his clothes” !  I quickly took him home and came back to watch Zac whose swimming has really come on.  He swam races in front crawl, breast stroke and back stroke and did a medley with all 3 strokes and then a relay race.  Then at 12.30pm it was home time.  Oh how I long for the later starts and the later home time that we have in the UK.

Front crawl, breaststroke, back stroke, fly....ain't no stoppin the boy 
So I won right, new world record, games record, Usain Bolt of the water???
Michael, the lovely Dutch dermatologist and his wife has left so we had a great leaving dinner for him at our house.  He has kindly let us use his car so we were planning on going on the Kilimanjaro mountain club trip to the Pare mountains that weekend.  On Friday night Josh still had a temperature but luckily no more vomiting and Zac did an enormous poo and seemed fine.  Aaron and Sebastian went off and did a big shop and hired tents/ sleeping bags etc for the trip.  I was prepared to stay at home with Josh as the camp site we were going to was at the top of the mountains and had no water at all and I did not think it would be a great place to be with a vomiting child!

The trip suddenly started to feel somewhat deflated!
Praying to the tyre god...nice arse though?

We had a quick lunch and then set off on what was meant to be an hours gentle walk with the children.  But of course this was a true African walk and it turned out that the guides did not know where we were going so we hiked through forest and when I say through forest I mean through the forest as there did not seem to be a path and we climbed over and under branches and pushed our way through sharp bushes.  Josh was not enjoying himself nor were the younger children so Camilla took them all back to camp.   Josh had been doing his hunched over look saying he felt tired and poorly but as soon as Camilla said they were turning back he stood up straight and skipped down!  The walk progressed but it was like one of those horror films when people keep being picked off at the back as we lost more and more people…..  Some people turned back because the going was too difficult/ they had to leave/ Edward had an itchy rash suddenly develop probably from a plant until Zac was the last child left!  Vicky and Susan suddenly appeared having found a much easier and straightforward way up the mountain and we all made it to the top.  Three and a half hours later we returned to camp after our “easy” walk to find that the wind was blowing a gale and the tents looked quite dodgy!
Fortunately Josh bounced up absolutely fine on Saturday morning so we all set off in convey for the mountains.  I was travelling with Camilla and her children and about an hour out of Moshi we saw Michael’s car stop as they had had a puncture.  Aaron and Sebastian efficiently changed the tyre and off we went again.  It was quite a journey and took about 4 hours as we climbed high into the mountains up very steep tracks to reach a secondary school perched right at the top with a fabulous view of Kilimanjaro peeking between the clouds. 

Paris Dakar via Tanzania AHT on a charge to the finish
Luckily we had discovered an unlocked classroom, which we made our cooking base.  We fed the kids who then had great fun building a fire and dancing round it with sticks whilst we cooked our feast of pasta, salad and amazing barbequed fillet steak.  By this time some of the tents had broken/ blown down and the rest were moved to the shelter of the classroom wall.  Aaron, Zac, Josh and I slept in the classroom, which was very comfortable, and in the morning we discovered that others had been wet through/ had collapsed tents overnight.

Happy, Sleepy, Sneezy, Bashful, Doc...Grumpy and Dopey were changing the tyre!
Is that some LEGO???????
After pancakes for breakfast, courtesy of Aaron, we set off for a  2 hour gentle walk again with the kids.  Yes you guessed it it was another African walk and although not through the bush after 2 hours I wanted to turn back.  Josh had stayed at camp with Aaron but I had Nogga and Zac who were getting quite hot and bothered.  It seemed impossible to get a straight answer as to how far we were going and whether we were taking the same route or a different route back.  The guide kept saying “5 more minutes” and Zac asked “is that an African 5 minutes or a Mazungu 5 minutes?” which made everyone laugh.  Of course it was an African 5 minutes and 20 minutes later we split into 2 groups.  Our  group headed back and the other group continued on to a resevoir and then back which was supposed to take an extra hour.  Of course when we finally got back to camp after another three and a half hour hike the other group were already back telling us that the resevoir had in fact been 5 minutes away and then they walked back a different much easier route!  Zac has now announced that he refuses to do any more hashes or long walks ever again.

We drove back after lunch and had a great swim at the ISM pool before collapsing after a hot shower into bed…..

Child Psychologist? Is there a Child Psychologist in the house? 

Zac took inspiration for Troll King from this self portrait. 

We have added a couple of pics of the children's pictures of the play from a previous post in which Zac played the Troll King.

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