This morning, we hopped out of our mosquito nets with a purpose. We quickly finished our eggs, toast, and of course traditional Tanzanian tea (compliments of Fatuma, our cook and housekeeper), and began our 15 minute trek to the clinic. As the red dust created a haze around us and stained the soles of our shoes, we stopped to take in the incredible site of Mount Kilimanjaro. We just can't take enough pictures of it, and truly the pictures don't do it justice.
When we arrived at the clinic, we sat in on the morning meeting and then we decided to split up into pairs. Brittany and I observed patients being seen in the clinic by the doctor. The first patient was a women who had recurrent breast cancer. She had been previously treated with chemo, radiation, and a mastectomy at another large hospital in Dar es Salaam (which is over 9 hours away via private car). Unfortunately, her cancer has returned and she is now being treated here at KCMC because it is close to the home of one of her relatives (when I say close, I mean she has to ride 2 daladala just to get here). She now has a large protruding tumor that causes her arm to swell, decreases her ability to move it, and ultimately causes her a lot of pain. It also needs daily dressing changes, however, she is too embarrassed to allow her family members to do the dressing changes, and she does not trust the inexperienced clinics near her home because her skin is very fragile, bleeding very easily. She only trusts the nurses at the CCC clinic, so she rides the 2 daladala everyday for her dressing changes. We found that the CCC staff are good improvising with the resources that are available. For example, the doctor noted that having a special vaseline dressing would be helpful for this patient's dressing change to prevent opening her fragile skin, but these dressing are hard to come by here, so Furaha, the oncology doctor, told the patient to by a special bee honey to dress the wound with instead.
As Britty and I sat in a hot, stuffy room watching one of the clinic nurses, Jane, intricately dress the wound, I realized what an uphill battle these oncology patients have. I imagined this mama with her painful arm climbing into a packed daladala with her only good working arm, squeezing herself into a seat, and riding along a bumpy road, not once but twice EVERYDAY, just to get a dressing change. I imagined how much more this lack of motion in her arm might affect her than an oncology patient in the western world, because of the lack of technological conveniences, such as washing clothes by hand, cooking, and even the need to trek through a busy open market to buy food. It is such a blessing for her to have this clinic closer to her, because it wouldn't be feasible for her to ride public transportation to Dar es Salaam everyday.
Another patient that Britt and I observed was a man with prostate cancer, who had blood drawn to check his PSA, which is a blood test that shows how bad his cancer is. We learned that it would take 3 months for him to get the result! In the US, that test would come back within a day or so, and 3 months would be unacceptable! Apparently, they have to wait until they collect enough PSA samples from other patients, so they don't waste reagents!
While Britt and I observed the flow of the normal clinic day, Cari and Kari revamped the chemo protocol sheets. The current sheets that are being used are very confusing for the nurses and redundant for the doctors. It was a huge process, but with a lot of guidance from our awesome Clinical Nurse Leader in MN, Jodi, the girls were able to completely change the sheet to make it much more succinct for both the nurses and the doctors. Of course, the whole process had it's road blocks: formatting the sheets turned out to be a tedious process with printing and re-printing, until they finally realized that the paper the clinic uses is not the standard 8x11 sheet of paper, rather it is 8.5x12...who knew?! After that discovery, the girls printed their final product and Furaha was ecstatic!
During this week, we discovered that there are many boxes of supplies that have been donated to the clinic from different organizations, but the nurses have not been using it, because they didn't know how to use it. So, a big task of today was sorting through the many boxes of supplies and deciphering what the nurses can use or not. After, we sorted the useful boxes, labelled them, and reorganized them in the storage closet. It was a lot of work, but the supplies are much more organized. One of the most awesome pearls from today, was when Kari explained to Jane how to properly connect the tubing together and give an IV push through it. Jane was so excited and we watched as she immediately turned to one of her peers and taught her the same thing. This is exactly what we want to happen: we teach some, so they can teach many! Kari was so excited about teaching that while she was explaining to the lead oncology doctor (Furaha) about the supplies, she squirted an entire syringe of saline in his face (including his eye) and all over his shirt. Needless to say, she turned a healthy shade of beet red as she feverishly apologized, while we all were rolling on the floor laughing! Lucky for Kari, Furaha was a good sport about it and laughed too, joking that she did it on purpose!
We also started to create education sheets to attach to the currently empty cork board in the infusion clinic.
After a long day, we stumbled along that familiar dirt road, and arrived at our house, envisioning a shower and a glass of wine. As we reached the door, we began to realize that no one had the key! Tired from our journey home, we all frantically denied that we ever had the house key in our possession that day. We tried all the doors, but to no avail! We were locked out, so close, yet so far from that refreshing shower and wine. While we frantically tried to call different people from the clinic, Britty transformed into Sherlock Holmes grilling us on where we were at what time and where the key was last seen! All of a sudden, there was a break in the case, and she discovered that Kari had a key to the clinic in her pocket--the key that Cari thought she had returned to Eveline, the clinic coordinator. Instead Eveline had the key to our house, so we packed up our bags and made the trek all the way back to the clinic to make the key exchange. We decided that from now on, when we leave the house, we will do a "surgery time-out" and ensure that we have the Right Key for the Right Door at the Right time (haha...a little medical humor).
Even though the trek back wasn't ideal, we got the chance to see the KCMC church choir practicing outside, as seen below.
Now we are working on our education materials for all of our presentations next week. I have to take a quick second to tell my "I told you so" story of the day! Because I was in Kenya for a year, I learned quickly that the power goes out often enough to warrant wearing a headlamp around at all times after dark. I have been hassled about my dorky headlamp this whole week, to the point of making it on Cari's snapchat story (haha). When the lights started to flicker tonight, as they do most nights, I scuttled into the bedroom and put on my trusty headlamp (cue heckling). Well, People! The power has gone out and guess who is the only one who can see what's happening? #respecttheheadlamp
Siku njema,
Nat
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