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