Week 2

We are still having a great time here. Will just add a few quick highlights/random comments:

- Audra went to a village up in mountains on Monday where she is helping w/ an group that finds specific needs (medical, educational, etc) and essentially helps to meet them. She said it was an amazing experience, the people had never seen a Muzungu (sp?), which means white person, in their little villages. She plans on frequenting many villages like this to provide assistance

- I acutally had an attending on my rounds twice this week and it was great. I am really learning so much it blows me away. Unfortunately, someone screwed up the intern's schedules so there is only one intern covering all of medicine (normally 4 for 4 services). B/c of this I am without an intern so it leads to an increased number of challenges. Still, I really enjoy it. One of these days I will post a blog just of great cases though this will likely bore most of you. When you come here you are supposed to meet with the head of the hospital before you start working but b/c he wasn't here they let me start anyway. Thursday after rounds I was doing a procedure on a patient and he, for some unclear reason, came on the wards and walked into the procedure room. It was quite funny b/c the next day I was in a meeting with a lot of people to meet him and he was so excited about me doing a silly procedure he made everyone clap for me. Then, I asked to be excused from the meeting (b/c it took 2.5 hours and I had not rounded yet) and in front of everyone talked about how there were a lot of liver abscesses here and the residents don't know how to drain them. He asked me to teach them. I then informed him I did not know how to do this (medicine residents do not do this in the states) but would read how to, do it, and then teach it. He was really excited. It was quite entertaining. 

- As many of you know, we love to host parties so we had about 25-30 people over and had a cookout. We played bocci w/ coconuts and a lemon but a dog came and bit one of the coconuts in half thus ending the game. It was so much fun and the most beautiful view of Kili to date (it is often cloudy, see below). Afterwards we projected a movie (Brewster's Millions) on a wall in our house. 

- Many of you probably think we are living in this very hot and sunny enviroment here, could not be farther from the truth. We have had light rain about 7 of our 19 days so far and most of them are cloudy. We are several months out of the rain season and this is quite unusual. It is also not that warm, it is the middle of winter here. That being said, it is the perfect temperature, highs in the upper 70s and lows in the upper 50s. It is slowly warming up by the day. 

- Because of our location in the world our days our quite short. Sun comes up b/n 6:30-7am and it is pitch-black by 7pm. B/c of this we are usually in bed by 9pm at the latest. 

- We have no TV. As hard as it is for many of us to imagine living life without one, it is so nice. Every night Audra and I spend time talking to each other, friends, or reading a book. We also play a lot of cards. If there is anything I have learned from this trip so far it is how important and great it is to live like this. 

- Audra's birthday is August 4th and I am taking her to Zanzibar for the weekend, we will be spending 4 days there. 

- We absolutely love the people here, they are so amazing. The woman are so hard-working, the carry everything on their head. Everyone is so friendly and they really love Americans (I was a bit suprised-most countries I have been to recently don't like us that much). I think a lot of this stems from the US giving a lot of money for HIV. 

- We eat really well here. There are a few places in town that make great pizza. Audra, as always, finds a way to make a great meal out of anything. Everywhere we turn there is fresh produce for dirt-cheap prices. There is a bread shop 10 minutes from where we live and every time I walk in there I get the biggest smile on my face because it smells so good. They have some of the best bread and pastries I have had anywhere in the world. 

- We attend this fantastic little chapel on the hospital campus here. The services are great and their worship music is amazing, anyone would enjoy it. Audra and I were trying to dance with some of them and I think we almost made them fall over laughing. Unfortunately, my dancing skills have not improved by changing continents. 

- Audra is getting some clothes made today. She bought 3 huge pieces of fabric for 10 dollars and there is a tailor coming to one of our friends houses to make all the girls dresses. My sister Michelle and Paul, her husband, are having a baby in a few months so we are going to see if they can make her some baby outfits from the material. 

Sorry for all the tangential thoughts. We will keep you posted. We are running our second Hash this afternoon. We miss you all and love most of you (sorry don't know who all is reading this blog). 

Cheers, 

Chris and Audra

Week 1

We have been here a little over a week and our really enjoying ourselves. Audra is currently spending most of her day at an orphanage named Upendo and helps teach there. She says it is amazing and really moving how the nuns devote their whole life to helping these children. She is also getting involved with a group that does some social work in rural villages. They will primarily be using her with children that have special needs. She will trying to leave a long-term impact by teaching the children's families how to teach them life skills and educate them. 

I have been working pretty hard in the hospital. For any of you who have been to Africa, you can imagine how things run. I am the most senior person that ever sees any of my patients from what I can tell. We typically meet in morning, take a tea break, then start rounding around 9:30. I typically have 30-35 patients on my service that I round on every day.  It is unique because you may order medicines for a patient, but when you see them the next day you will find out they never got the medicine b/c if the medicine is not in the hospital they must send a family member to another place in town to pick up the medicine and often the family member does not do it. You must really change the way you practice medicine. The other unique thing is that you must do most of your own procedures.  Sorry for the medical lingo but I have already done a bone marrow biopsy on my own, countless lumbar punctures and thoracentesis, and will being doing pleural biopsies, liver biopsies, and pericardiocentesis in the future. I am quite excited. Typically I am doing bedside rounds 5 hours a day. I will save some of my very intersting cases for another blog. 

Last night, Audra and I were walking in the city and we saw one of the patients I had discharged that day. He was so grateful for all of my help and insisted that we come with him for a drink. I agreed and followed him to his sister's shop. There he proceeded to buy me several beers and we talked about the history of Tanzanian politics for an hour, it was fantastic. 

Last Sunday was our coolest day to this point. I am not sure how many of you have heard of a Hash, but they are so much fun. These are done throughout the world and are essentially a grown up "scavenger hunt"- kind of. Some makes up a course that is anywhere from 6-10 miles marked by flour. Everyone starts together and functions as a team to find the finish. Throughout the course you will find an X and that means everyone must break up in different directions to find where the trail starts again. When someone finds it they yell on-on and then everyone starts following them again. It last around 2 hours and is so much fun. At the end you arrive to a finish line where burgers, hot dogs and beer await you. Ours was so much fun, it was set in field right at the bottom of Kili and we ran through corn, coffee, sunflower, st. John's wart and flower fields as well as many little villages. I had to also cross a river twice where I was waist high in water. It was so much fun. I acutally saw a baboon when I was running around. 

The people at the hash were so cool. It is really amazing to here the stories of the many people that live here. There is a guy named Simon who is an ultra-runner and owns a trekking business here. He is a native Tanzanian. He holds the record for going up and down Kili- HE RAN THE MOUNTAIN UP AND DOWN IN 8:30 HOURS. Unbelievable. Apparently if his climbers need something he just runs up the mountain and gives it to them. There are many other incredible people here as well. Most night we end up getting together with some and playing cards. 

It is great to here from everyone and we enjoy your comments. We will keep you posted on all our new events and I promise to provide more entertaining stories in future. 

Cheers, 

Chris and Audra

Hallo

This is a quick update with a pic or two (we tried to add more but it took way too long, we will do more later). Sorry I picked our worst picture of Kili by accident, we will put better ones later. Audra met with a Catholic orphanage this week and is going there on Monday to look at working there. She is very excited but was amazed at how humbling the circumstances were. She might also do some research with a Duke OBGYN on effectively educating Tanzanian women on healthy pregnancy practices (Mom and Dad don't get your hopes up). 

I had a crazy day on Friday- just me and an intern. We saw 35 patients (it is really not that much worse than Duke Gen Med- kidding) and had some fascinating cases that I have no clue what is wrong with. I have been thumbing the tropical medicine textbook quite a lot. I did diagnose a kid (Internal Medicine takes care of everyone over the age of 13 in Africa) with nephrotic syndrome yesterday after one year without a diagnosis, that was fun. You would be amazed at some of the things they can do in this hospital including almost everyone with edema or ascites or dyspnea getting an ECHO, I think they are second only in Duke to this, though here it cost 4 dollars and at Duke 1500. I also was helping my intern when he got a crosscover call on a patient on the women's ward (I only care for men).  She had come in with stroke and now was completely unresponsive. Unfortunatley, I got to teach him what fixed and dilated pupils looked like as she likely had a haemorragic (british spelling) stroke and herniated. I tried mannitol and steroids knowing it would not help, but there is no neurosurgery or even intubation with hyperventilation here, I am sure she has passed. The strange thing is you do it all by exam, no CT. Anyway, I will fill more details in later. 

I went on an amazing 10K run yesterday that started at our house and ran through all these little villages where kids in "huts" come out and give you five and say "Hallo" when you run by and locals run for 3-4 minutes with you for fun at times. The whole way at you are looking directly at the peak of Kili, it is beautiful. It was so much fun. 

Audra, as always, has proved herself to be the amazing cook that she is, cooking here fabulous pasta with home made tomato sauce though it looked quite challenging- there is no tomato sauce, just tomatoes. It was very good. We are taking good care of each other and will keep you posted on all the latest events. I also think I am going to add some medical post for the doctors out there. I could use some help trying to make some diagnosis and treatment decisions and think it would be fun for all.  I hope you enjoy the pictures.

Cheers, 

Chris and Audra

Jambo!!!

Jambo!!! This means a lot of things in Swahili including hello and is an approprite start to this blog. We arrived in Moshi (at the foot of Kilimanjaro) on July 8th. We had an appropriate introduction to life here by having one of my bags left in Amsterdam by KLM for unclear reasons then riding 45 minutes in a "SUV" w/ 9 people in it (6 of which were moving here for 1 year) and approximately 20 bags on the roof of the car. It was fantastic. We arrived in the doctor's housing at KCMC (Kilimanjaro Christian Medical Center) that night and hit the ground running the next day. We arrived in the middle of the night so I could not see my surroundings but when I woke up the next morning to see the snowy peaks of Mt. Kiliminjaro from my house fell in love.
Yesterday I got my "orientation" to the hospital (though I am sure I will remain disoriented for my whole 3 months here). I am still not sure exactly what my duties consist of but that part I am sure I will learn fast. I had a 2 hour break between meetings yesterday and was told I should try to "go in town real quick to get a SIM card for my phone". I assure you that quick was the wrong word to describe my next experience as I packed into a mini-van that functions as a shuttle that packed about 20 people into what would typically carry 7-8 in the US and became a fun journey. I know my wife tells me I can smell at times but I am pretty sure I was the best smelling person on that van. Anyway, it was a lot of fun and quite eventful in the downtown. Later that day Audra and I went back into town and I paid 12 dollars for a cab driver to take us around the markets and other stores so I could figure out what kind of deals I good get on produce. At the end of the day we went to these fields by the hospital and played ultimate frisbee with a bunch of locals (who would have thought that was big in Africa) until the sun went down with Kilimanjaro towering over us. It was surreal.
This morning I started my time on the ward and have already begun to see some fascinating cases. I made quick friends with the chair of medicine here and by mid morning we were grading students on their patient interviews together (by the way, they are not quite as touchy feely as we our in the states, he made one of the students cry in front of me). I then joined my team for rounds and I had some awesome cases just today- 2 cases of portal htn w/ ugib 2/2 schisto, 1 kaposi sarcoma, 1 TB, 1 brain lesion of unclear etiology w/ R sided weakness, one old rheumatic fever now w/ heart failure and one ascites of unclear etiology. Anyway, it was really fun. Tonight is pizza night and we are looking forward to that. Audra is currently sorting out where the best place for her to work is. We are both having a blast. I promise blogs at least once a week and they will usually be much more entertaining than this. I will also be putting pictures up as well. You can communicate with be by posting a comment on the blog or emailing me a chrismeduri@gmail.com

Cheers,

Meduri