Friday, October 23, 2009

One Week After Returning

Last week I got back from Tanzania. I did not have access to reliable internet during my time in Shirati, so unfortunately I wasn’t able to post on this blog as I had hoped. Nevertheless, I wanted to send an update to people who may be interested.

On behalf of the staff and patients at Shirati Hospital, I want to sincerely thank everyone who donated money for your generosity. In addition to the bags of medical supplies I brought with me, we were able to leave them with a cash donation of $1,900. The majority of this has already been used to purchase vital hospital supplies and medicines. Literally thousands of doses of life-saving medicines were purchased to fight malaria and other serious infectious diseases such as pneumonia, meningitis, and typhoid fever (sulfadoxine/pyrimethamine, amodiaquine, ampicillin, chloramphenicol, metronidazole). Other supplies purchased included thousands of sterile and non-sterile gloves, infusion supplies, and much-needed lab reagents (i.e. to measure glucose, protein, etc), all of which where usually in very short supply.

Of the supplies I brought in my luggage, the items that seemed to be particularly welcome were sutures, laryngoscopes, iodine scrub (ALWAYS in short supply), and vacuums for vacuum-assisted vaginal delivery. A few of the doctors said the hospital no longer had any vacuums, and so if a woman had a prolonged second stage of labor they had very few options to help mom and baby except to do a c-section. They were very happy to have the vacuums that I brought and were eager to use them. I personally used several of these supplies myself while I was there, including a pediatric nasogastric tube to feed a severely malnourished child, and a lumbar puncture tray to do a spinal tap on a young father with HIV and meningitis. The child was incredibly sick, with an initial hematocrit of only 5%, and I honestly think he would have died without the feeds he got through that tube. The young father turned out to have cryptococcal meningitis, and, thanks in part to the diagnostic information provided from the spinal tap, he improved after several days of treatment in the hospital. I mention these patients to give you a sense of how even the most basic of medical supplies can have a very profound impact on people in an area where resources are scarce.

Thanks again to everyone who donated. The supplies and medicines purchased with your donations are sure to have a positive impact on many people.

Time permitting, I will attempt to post a few stories from the hospital in the future.

Saturday, September 5, 2009

Final Preparations

I leave for Shirati in a little over a week. Before then I still have three overnight calls on OB, and just one day off. So I am trying to make my final preparations early.

Last Monday I went to MedShare in San Leandro, “shopping” for medical supplies to take with me to Shirati. It was an amazing place. Blair, thanks for telling me about it. Chuck the Executive Director was incredibly friendly and showed me around their 35,000 foot warehouse. It was piled high with donated medical supplies: everything from gloves and suture to exam tables and anesthesia machines. They even had a mammography unit and an high-end ultrasound machine. The bigger equipment is packed onto 40-foot containers and shipped to low-resource health centers around the world at deep discounts.

I spent about three hours there and collected 4 big bags of supplies. This included suture, gloves, gauze, IV supplies, anesthesia equipment, BP machines, Foley catheters, nasogastric tubes, assorted minor procedure instruments, and much more. I also got a laryngoscopy set. The cost was EXTREMELY low. Thank you again to everyone who donated money. Part of the donations were used to pay for these supplies. After the purchase at MedShare, there is still nearly $2,000 in donations that I will be taking to Shirati Hospital to purchase medicines and other supplies. More details about the purchases in Tanzania to come later.

Supplies purchased from MedShare with donations

For anyone involved in international medical work, I highly recommend checking out MedShare. They are an amazing organization doing wonderful work. I am going to contact our hospital administration at CCRMC to see if our hospital can become a regular donor of supplies to MedShare.

When I’m not at the hospital I’ve been reading up as much as I can on management of the common conditions I expect to see in Shirati. Mainly malaria, malnutrition, HIV, TB, other infectious diseases. I’ve purchased a few WHO books and a couple of MSF books as my main guides: WHO Hospital Care for Children; WHO Surgical Care at the District Hospital; WHO Guidelines for Treatment of Malaria; MSF Clinical Guidelines; MSF Essential Medicines. I’ve also been reading Blair Thedinger’s blog, a friend and co-resident, about his ongoing experiences in Uganda. Check it out:

I’ve spoken with Dr. Chirangi at Shirati about my arrival plans. He advised me to take a bus from Nairobi to the Tanzanian border. From there they will try to send a car to pick me up.

Again I want to sincerely thank everyone who donated money to me for Shirati Hospital. I’m confident the medicines and supplies from these donations will help many people.

Monday, July 6, 2009

Preparing to go to Tanzania

As part of my residency training, I have the fortunate opportunity to work abroad and learn more about providing healthcare in low resource areas. This September I will be going to Shirati, Tanzania to work in a district hospital for four weeks. I have started this blog to share my experiences during this trip with friends, family, co-residents, and anyone else who may be interested.

Shirati Hospital

Since I began medical school my intention has always been to serve in low-resource areas, in international settings where medical access is scarce. So I'm really looking forward to this trip, which will be my first opportunity to work internationally after medical school. I will be working and training in Tanzania under Dr. Chirangi, the Chief Medical Officer of Shirati Hospital. I initially got in contact with him through Nishant Shah, one of the fabulous recent graduates from the residency program who worked in Shirati Hospital as a 3rd year resident. Dr. Chirangi has been very warm and inviting, and welcomed me with open arms to come spend time working with him at Shirati.

In preparation for my September visit, I’ve read about healthcare needs in Tanzania and talked with Dr. Chirangi about specific needs in Shirati. I’ve also been working with one of my wonderful co-residents, Blair Thedinger, to look into ways to bring much needed medical supplies and money donations to Shirati when I make the trip. (Blair is going to Uganda next month and is doing parallel work to bring vital supplies to the hospital he'll be visiting in Tororo). I’ve contacted a non-profit called MedShare International that helps to collect donatable medical supplies in the United States and distribute them to medically underserved areas around the world. With their help, I plan on packing extra bags with me on the plane stuffed full of 100 lbs or more of the critical medical supplies that Dr. Chirangi has told me the hospital needs most.

In order to help fund acquisition and delivery of these supplies, I’m welcoming donations from anyone who is interested. You’ll see at the top of the blog a “Donate” button from PayPal, which you can use to make a safe, online donation with any major credit card. All of this money will go directly toward the delivery of critical medical supplies and purchase of vital medications for Shirati Hospital. I’m not a 501(c)(3) and so I can’t give you any tax deduction, but I can give you my assurance that all this money will be used for these direct purposes. I’ve already paid for my travel and will not be using ANY of this donated money to pay for travel expenses. Any donation, big or small, helps immensely. Estimates for reference:
$10 - Helps the hospital provide life saving vaccines to 10 children
$25 – Gets 15 pounds of critical supplies to the hospital from the US
$50 - Provides inpatient antibiotic treatment to 10 patients.

Ward at Shirati

Shirati Hospital is located in northwestern Tanzania along Lake Victoria near the Kenyan border. It is 2 hours from the closest town and 5 hours from the nearest main city. 80 percent of the population it serves lives below the UN poverty line. It began as a Mennonite mission hospital in 1935, and has grown to include a wide range of inpatient and outpatient services. The inpatient hospital has 150 beds, which are often filled to capacity and at times are shared by more than one patient. Services include general surgery, pediatrics, internal medicine, obstetrics (including C-sections), HIV clinics, antenatal care, basic lab and pharmacy. Some of the more common illnesses seen include malaria, HIV, TB, and diarrhea. There is an operating room and they regularly perform a wide range of general surgery procedures and C-sections. Medical supplies are always in high demand. As Dr. Chirangi explains, “…several things are missing, and we run on a shortage of supplies.” Items most needed include basic materials such as surgical sutures, needle driver, surgical scrub materials, blood pressure machines, laryngoscopes (for intubation), pain medicines and antibiotics.

I hope to update this blog during my travels with stories and (if possible) pictures. I will also send updates to any people interested in donating to let you know how the supplies have been used, and what impact your donations have made.