The past two weeks in Bagamoyo I continued working with volunteer Kirstine. I got flu for few days but luckily it was not serious illness. We had a great success at World HIV Day and continued home-based care with our old and some new patients.
Kirstine created patient record system with Excel program to record all the people who come for testing at the office. She also collected all history of CD4 counts from our home-based care patients and we weighed most patients with new scales we purchased (some of the immobile patients we were not able to weigh). From the information she created a graph so we can see and monitor the progress of our patients. This is something that was planned long time ago but it was Kirstine finally who followed it through and she made a great success.
World HIV Day 1st of December was a great success too. Godfrey came from Dar to help us and together with Charles set up a spot to the middle of the bus station and test people for HIV. Chanzi also gave a hand with setting up posters and we had lots of stickers and red ribbons that were donated from UK based HIV Charity through Debbie; our faithful sponsor and volunteer from the UK. 54 people, young and old were tested on that day! One older man tested positive and was referred to CTC at the hospital for a follow up and more counselling. He had a strange reaction to his results; he was happy and said ‘It is OK because now there is good treatment for it.
Couple of weeks ago Kirstine organized to have testing for pre- school children at our UKUN/PHI office. Two groups of 10 came in two different days. No one was found positive. This was a great idea and something we should expand to the other schools at Bagamoyo too.
Update of patients:
Patient G from Morogoro family:
We have been visiting patient G weekly and every time we see him he looks healthier and he is getting stronger. He had his hospital appointment for refill of ARV medication. He still reports dizziness and doctors told him he has a low blood pressure. We have been checking it ever since and it is within normal range. Otherwise he has no other problems. He has gained even more weight and his mobility is almost back to normal. I gave him multivitamins for a month and we give him porridge and fruit every week. He is missing his family greatly but soon he will be fully recovered and go back home to his wife and baby boy Michael. Hospital still has not received results for HIV test from the little boy Michael. This sample was taken about two months ago now and sent to Muhimbili Dar Es Salaam. I wonder if we will ever get them. I will attend his next hospital appointment with him on New Year ’s Eve.
Patient Z and her daughter Hadija we visited both weeks but found that they were not home. Apparently Hadija works now near the beach every day and her mother Patient Z had gone to the farm. Last time we saw them was a month ago and luckily Patient Z had recovered from her stomach ulcers and had got back her mobility. We are not concerned and they have our number if they need us.
Patient A & Patient H - Tanga family
We visited Amina and her brother H to talk and help about plan for future and getting out of poverty. Their health is stable now and patient A continues her physiotherapy with exercises and walks with her frame. Hamisi has fully recovered from his operation and we helped to restart his cigarette business few weeks ago. Now he reports that is going OK. Patient A had been keen for a long time to sell something too outside her house and we supported her with bagging and selling bags of charcoal. A big bag of charcoal to start the business with cost £12. If this business works out well for her we will increase the business and add firewood too to sell. Due to her mobility she can only sit down (and walk short distances with a frame) so selling things outside works well for her. They are both very grateful of our support and we will review them next week.
Patient MP, our palliative care patient was supposed to have her monthly hospital appointment on the 6th of December but family did not want to take her that day. This has been continuous problem the whole year. We visited them with Kirstine later that afternoon to assess her condition only to find her in a very ill health. Patient MP appeared to have had lost weight again after last hospital admission (she had Meningitis), which was last month. Family reported that she is only eating very small amounts and not taking medication. In my opinion she looked like she did not have many days left in this world. Family said they did not want to take her to the hospital again for feeding with nasogastric tube. I understood their decision and said it was up to them. She has been on this stage of ‘suffering’ for many years now (stage 4 AIDS). Her eyes looked almost black and had no ‘life’ in them. She was not responding to voice or pain. I held her hand and wished that she would feel no suffering. She did not look agitated or uncomfortable. Family had already spoken to Patient MP's sister Mama Kizenga and she had told them that patient MP has suffered for too long. Her daughter asked me why is she like this and if she will die now. I told them I think patient MP is tired of life. I told them to call me if they get any worries. We went back few days later and MP looked a little better again. She did not look like she was in any pain or was uncomfortable. She had little temperature so we gave her liquid Paracetamol, which she swallowed. That day her daughter told me that she had had porridge and juice. We will visit every few days to assess her comfortability. I feel really sad as I have grown very close to her this year but I know that she has almost no quality of life. The smiles have now gone.
Patient ZM Ramadhani and her children:
This frail 29 year old lady called Zena came to our office few weeks ago with her three children. Patient ZM and Ramadhani Dotto her eldest son of 8 years are HIV positive. They had not been taken medications ARVs because of lack of support and nutrition. Now the hospital gave them to restart again. The family fled from their home a week ago due to stigma. Now they stay in another small house with two rooms.
We went for a home visit last Friday to assess their needs. Patient ZM is very malnourished, 35kg only. She has been coughing blood, has diarrhoea, stomach pain and has ulcers in her mouth. She was dehydrated, her blood pressure was low 90/70, heart rate 120bpm and temperature 38 degrees. She was also breathless. Two weeks ago she went to Bagamoyo Hospital for a TB sputum test and they gave her medicines for her mouth. Now she went to get her result but they could not find them. We gave her Paracetamol and promised to go to the hospital to find her results. Her last CD4 count was done one year ago and it was high 1291. Ten months before that it was only 195. It must be very low now too. She really needs a new one done. Her son’s last CD4 count was done one year ago too and it was 1282. They have both attended their monthly hospital appointments regularly but why has the CD4 not been checked. This is a big failure from the hospital. They both have their next clinic appointment at New Year’s Eve 31/12/2013 and I will make sure to go with them to get it done.
One of the children at their house was lying on the floor holding his stomach and saying he was hungry. All the children appeared small but not as malnourished as their mother Zena. We gave them 1kg of porridge and sugar and told the little boy to get up and start cooking it. He started to make a fire inside the room with firewood and washed a pan for cooking. They do not have a local cooker even. One of the children asked for a bicycle. They have no food but of course those things can seem more important to a child. They have no money or income. They were waiting for Zena’s mother to return in the evening to bring food and cook for them. On Sunday I went back with Chanzi and took lots of foods for them; bananas, rice, potatoes, vegetables and drinking water. First thing we need to do on Monday is to find her TB results so she can start a treatment if it comes back positive.
New Patient JJ:
We got our first referral from CTC with our referral forms we created. This was Patient JJ, 56 year old lady who is HIV positive. She was referred to us for physiotherapy and transport to hospital. Charles from our office said he knows her and this lady apparently cries a lot.
I went for a home visit with Kirstine last Friday morning. A local lady who is taking care of her took us there. Shew told us that JJ's family had abandoned her so she was alone otherwise. We found her lying on the floor and she started to cry when we came. She was not able to walk and had lost her mobility about one year ago. She was able to speak a little through her tears and said her legs were painful. She seemed anxious too.
We checked her physiological observations and her blood pressure was high 170/120. I checked her other arm and it was even higher 170/130. Her pulse was 120bpm and respiration 28bpm. She had no temperature. She had been to the hospital last September (2.5 months ago) but they had not checked her blood pressure. She was not on ARV medication; in fact the only medication she had was Vitamin B tablets. Her CD4 count was done September too and was 451. We decided to take her to the hospital to see a doctor for her blood pressure. We had to carry her into the bajaji (three wheeled small car) and she was not light! Once we arrived at the hospital and got through to the doctor he did not seem happy because it was not her ‘appointment date’. I explained about her blood pressure and he asked me to check again there at the hospital. It was still high. Doctor asked questions about her history and started to be helpful. She was started on two different blood pressure tablets, Diazepam for anxiety and Diclofenac for pain. Doctor told me to go to check her blood pressure the next day. We took her home and explained about her medications. I went back next day and her blood pressure had dropped to 140/80.
She appeared tired but that was possibly due to having been started on Diazepam the night before. I omitted one of the blood pressure medications as the doctor had advised and she continued with the other. We will monitor her every few days at first. When her blood pressure becomes stable we can assess her mobility and possibly start physiotherapy.
Next week we will be busy with new patients and luckily we have a new volunteer Bjarne to join us. He is a student nurse from Sweden and will be with us for ten days. Kirstine has another two weeks left with us. It will be my first Christmas here in Tanzania in two weeks time and I am looking forward to it!
The past two weeks at Bagamoyo we had a great team of 4 volunteers. I was away the first week in Zanzibar but Debbie, Godfrey, Kirstine and Charles took good care of the patients. We continued home-based care, did regular visits to Mariam at the hospital, did testing at the office and put out posters to promote our office HIV testing. Unfortunately we were sad to see Debbie and Godfrey to go last week as they were such a great asset to us but they have both promised to come back soon. We were fortunate though to receive help and medical supplies from Kirstine’s boyfriend who is visiting here. He is a doctor specialized in surgery and will give us plenty of teachings on medical assessments!
MP was put on a drip at home for couple of days but we knew it was not enough as she was not swallowing any medicines at all. Her diarrhoea continued. We obtained a blood sample from MP and took it to the clinic to check malaria and it came back negative. Finally the next day Mariam’s family agreed to take her to the hospital for feeding. I was relieved as I was going on a trip to Zanzibar the next day. She was put on Sodium Lactate drip (that was almost impossible to get from Bagamoyo, luckily found one in our office!) and they discovered that she had meningitis. They treated her with IV Fluconazole for few days. She had nasogastric tube inserted and was fed porridge and medicines through it as she was unable to swallow for several days. After a week she was better and discharged home. Mariam appears just the same as she was before this illness. Peter Kirstine’s boyfriend assessed her on a home visit and also said there is not much we can do for her, only palliative care to keep her comfortable. We put on some new medicine dressing to her pressure sore and it appears to be healing. Debbie’s gift Sudacrem is also a great help for her. She appeared comfortable but we will get some small cushions to put between her limbs for pressure care. Mariam is able to swallow again but is eating only small amounts of porridge. She is refusing to drink ORS (oral rehydration salts). Family were grateful for all our support; we gave them more gloves, disinfectant and juice for Mariam.
Unfortunately AB got sick at the office for couple of days. We all assumed that it was due to him missing out three day of his ARV medications! We told him off for not being compliant with ARVs and the consequences that can follow. We told him he is throwing away his opportunity to start the art school in January if he will not be well enough.
The second day evening we took him to the hospital to see a doctor and after some blood tests they discovered malaria. He was given medications for three days. He appears already better from it. He needs repeat medications for malaria this week and then next week to retest. Peter brought him a present from Denmark; a pillbox with weekdays written on it! We can keep proper check on his medications and it will be hard for him to miss again. He has understood how it works and is all motivated again to get himself healthy for GOIG School for January 2014 J
CPT continues to get our support for two showers a week, laundry, cleaning and exercise. Debbie and Kirstine took him for a walk on his wheelchair whilst I was in Zanzibar and he really enjoyed that! He received a new ‘mohican’ haircut and a shave from Godfrey and a new bucket that is easier to empty for his toilet chair. Peter assessed his mobility a little last week and told us to continue with the chair exercises. The exercise pole he said would be so great for him but after the family took the last one down we are hesitating to waste our time to build another one. Peter is not the first doctor to tell CPT that with some exercise and building more muscle to his thighs he could walk again. Peter also discovered that CPT has scrotal hernia, which Captain was aware of already but as he experiences no pain it should not be dangerous. CPT was showing of his big arm muscles as usual and his ‘pot’ belly but Peter told him his swollen stomach was not fat, just ‘air’ but his arm muscles are real at least.
New family :
A family that was known to UKUN/PHI office a long time ago came by the office last week. It was a mother with her three children. Her husband had died. Mother is HIV positive and her eldest son of eight years of age. Both of them are not taking medications (ARVs) due to lack of support and nutrition. The other two younger children fortunately tested negative. Mother appeared severely malnourished and weighed only 37kg. Debbie and Charles gave them some food at the office and we bought 1kg of porridge if they come back next day. The mother went to the hospital twice in two days but we never saw her again at the end of the second day. Therefore we do not know what the doctors had told her and if she was given any medications. We need to go for a home visit this week to assess their housing situation and assess all the family members’ needs for support.
We had a lovely ‘Thank you & see you later’ meal for Debbie and Godfrey at Poa Poa restaurant here at Bagamoyo. Both of them will be back soon to volunteer with us.
We have been doing a shoe and necklace campaign with two local artists; Chanzi and Zakaria to raise funds for our patients. Debbie has taken the order to Europe; 20 pairs of shoes and 11 necklaces. With this we managed raise over £100! We also received another £60 for Kathy’s cake sales from Plymouth! Great stuff!
This week there are no volunteers working with me but luckily none of our clients are critically ill this moment. Kirstine and Peter are coming back from their trip from Zanzibar at the weekend. Sunday this week, 1st December will be the ‘World HIV Day’. We are still finding out where it will be happening in Bagamoyo but certainly we will be joining in with testing, information, free condoms and red ribbons!
The past two weeks with HIV project in Bagamoyo were busy with visiting patients and introducing new volunteers to our team. Volunteer David left our team and Charles was still away for another week.
Debbie, an ex- volunteer from UK came back to help us again; for the third time. She is staying three weeks this time and has been a great worker and fundraiser for couple of years now. She just keeps coming back! I have been lucky to have her living at my house and she has become a great friend to me. She loves helping people and brings great new ideas to our team. Another lovely volunteer joined us last week; Kirstine from Denmark. She is staying here for a whole two months! Kirstine came through Action Aid Denmark and stays with a local family with another Danish girl.
That is a great way to learn about the local culture and language here and to understand our patients’ life in Bagamoyo. She is also very keen and full of ideas. We completed our referral forms to UKUN/PHI and gave some to the hospital already. We have also designed a poster to raise awareness about our office HIV testing as the numbers have been down. This is also due to our ‘new’ location so we need to take action to make people more aware. Kirstine also has an idea to advertise in a local HIV magazine or some newspaper here and to paint a big red ribbon to outside on the office wall. Bot girls with Godfrey are also keen to do big promotion day at weekly TopTop market (Mondays) for a free testing. It was done once before few months back and we managed to test over 40 people that day! We have been busy visiting our home care patients and introducing them to our new volunteers with Godfrey.
Newly diagnosed family from Morogoro had some changes for the past two weeks. Mother A left home with baby M to Morogoro for ‘few months’ and G and his 7year old son remained here to be looked after by Mama Ponda’s family.
Apparently there was not enough money to support the whole family in that household so the most sick stayed; father G. We visited him couple of times to give porridge and extra snacks and physiotherapy. He is still malnourished and feels dizzy occasionally but appears a little ‘healthier’. He is now able to mobilise quite long distances without his walker and seems happy in himself. He finally received his referral letter from Morogoro to be able to receive his ARVs here regularly. We will continue our support with him.
Patient HT & AM:
Patient HT and his sister AM appear both in good health. HT came back to Bagamoyo finally after fully recovering from his operation in Dar. We organized a little welcome party for him at his house with coffee and cakes! He received a nice new shirt from Debbie and looks like a new man! He restarted his cigarette business (not such a healthy thing but it was his income for a long time with a good profit before he got sick so he wanted to continue), which we supported with a little capital. AM is keen to start some business too which she could do from home and we are working on the idea. Unfortunately her mum who lives with them, lovely old lady of nearly 80 years got sick with flu but she is on her way to recovery. We gave her medicines for two weeks. Next week we will review her and HT's business. The family really needs an income to survive.
Patient Z, our new patient, who is suffering from peptic ulcers and reduced mobillity has majorly recovered since we first met her few weeks ago. Her abdominal pains have lessened and she continues to take Ranitidine to stop acid production. She can walk long distances now with her stick and has no problems with toileting. Constipation has also resolved now. Seems like another successful story for our home-based care team. We will continue nutrition support with weekly porridge and review. All physiological observations are stable. She complained a little tight chest but it seemed clear when listening and her respirations were 22bpm but she had done exercise. She has her monthly CTC hospital appointment next Monday and her daughter Hadija will go with her but we will pay for transport (bajaji).
Patient MP had a good two weeks without problems until today (Sunday) afternoon when I received a phone call from her family. They reported she had diarrhoea. When I got to the house I discovered she had a fever and severe diarrhoea. She had had watery stools several times. Family refused to take to hospital as Mariam was too sick to travel. Blood pressure was 90/70 and she appeared dehydrated. Family found it hard to give any drinks as Mariam was not swallowing properly. I gave liquid Paracetamol and she managed to swallow that. We gave ORSs (oral rehydration salts) to the family to give to Mariam and left them with more liquid Paracetamol and nappies to wear over night. We went back later with Debbie and Chanzi to cannulate her and put up a saline drip over night. She was not swallowing any of the ORSs. We will review tomorrow morning and try to get a blood sample to rule out Malaria.
We were busy with groups of students from Dar Es Salaam in both weekends. I went to Dar for medical stock and patient Hamisi’s appointment and we did a trip to GOIG School with Abdullah. We lost one life here unfortunately and another life that I witnessed in Dar in motorbike accident. We got a new patient for home care and took Mariam to the hospital for her results.
Updates of patients:
I was very lucky and to meet and live with a wonderful finish girl called Minna for almost two weeks. She is an artist and was studying sculpture here in Bagamoyo. Fortunately she had many contacts and also studied in GOIG Art School in Mbezi Dar Es Salaam. Once I told her the story of our orphan patient AHM, Minna had a great idea to take him to visit that school. So together with Minna, Chanzi, AHM and Zakaria (artist from Bagamoyo) we went on a day trip to Mbezi. First GOIG School followed by a lunch and afternoon relaxing at Mbezi Beach J
GOIG School is sponsored from my country Finland and they teach many kinds of art e.g. batik, drawing, making rugs, carpeting, stone art, jewellery etc. They also teach basic skills of Swahili and they offer English language classes, which Abdallah is really keen to take. After meeting with the teacher AHM was offered a place starting from January 2014 for one year. It was all too exiting for him and soon after he fell asleep at the beach! They told us that they will find one skill from him, which will probably be drawing/painting and they will concentrate to teach him that for the whole year so he can become very good at it. He has a big passion for drawing already. His fees and accommodation will be free because he is an orphan, which is so nice of them. All we need to fundraise is his meals and little expenses like phone. Once a month he can come to Bagamoyo to take his medications from the hospital (ARVs) or one of us will bring them to him. The school is aware of his HIV status but there is no worry about it as long as we keep close contact with him and the school from UKUN/PHI.
His health is pretty stable. Abdallah was due to stop his TB medications last week but the doctor gave him couple of weeks extra due to cough and his CD4 being as low as 159. He has started to exercise (doing push ups)at the office to get some muscles to his new built body; he is 45 kg now, which is 11 kg gain in seven months! He is feeling happy in himself because he knows that finally this will be his chance to a new different life at GOIG School. Since the trip Abdallah keeps asking EVERY DAY: ‘When do I start the school?’ He is driving us mad but we could not be happier for him!
The same day after Mbezi trip I went to Dar in the evening. It was the EID celebrations (islamic holiday). Unfortunately I witnessed a very bad motorbike accident. A car drove into the motorbike and then drove off fast leaving two people injured; young boy and a girl. The motorbike was in pieces. When I got to the injured girl someone was already taking the other less injured to the car and they drove off leaving the girl lying there. Why could they not take both of them? - I was thinking. There were lots of people shouting and pulling it was a total chaos. My friends helped to push people away so we could go to check her condition. She was still breathing and I begged to get her to the hospital in a car as I realized there will be no chance of getting ambulance (no one knows numbers and apparently they could take hours). People were pulling her from every direction; I have never seen anything like that. She was unconscious but people tried to put her on a motorbike panicking, and she kept falling off. I felt helpless, in shock and angry same time. I shouted to put her down and I saw her head bleeding. When I checked her again she had no pulse and was not breathing. CPR, CPR CPR! - I thought but before I knew people had pulled her again and this time dragged her into a backseat of a car. I was shouting ‘but she is dead she needs CPR’. I begged them to let me into the car at least to the backseat but they wouldn’t and drove off. From over 100 people there were NOONE who knew even little first aid or how to deal with injured people and RTAs (road traffic accidents). The main thing was that she was alive before all the pulling and dragging. She could have possibly survived, never know. I felt massive failure from my part and so sad with the lack of knowledge of these people. There is a MASSIVE need of educating people for basic first aid.
I could see panic in those people’s faces and most of them wanted to help but didn’t know how. Some kept asking what I want them to do. They were also lots of thieves taking their opportunities. One girl was checking the pockets of the ‘dead’ girl. It was disgusting. Next day there was another death from motorbike accident in same area. The third day finally road traffic police arrived to supervise. There accidents are too common here. Most drivers and passengers do not wear helmets, some ‘drink and drive’ and some just drive crazy stupidly wanting to ‘show of’. I taught those local friends who witnessed the accident some basic tips when they arrive into an accident and how to resuscitate someone who is not breathing. This issue need to be more addressed and I surely want to do more about it. It was the biggest shock to really understand how lucky again we are with our health care and ambulances in the developing world. All the government workers have luxury cars but they cannot spend some money for an ambulance. Many people also told me that once you take someone to the hospital it is not easy to enter, the police wants to question you, possibly money and often they do not let the injured inside until they go to their home first to get their hospital card and number. That is too crazy. I have probably been here too long as I was not shocked at all when I heard that.
And to happier things…
The day after witnessing the RTA in Dar I went to Muhimbili Hospital with our long term patient HT for his booked appointment. That day he was finally discharged from Muhimbili Hospital and he is now on his way back to Bagamoyo.
For many years he was suffering from painful and embarrassing gynaecomastia (enlarged male breasts). He finally had his operation; Double Mastectomy one month ago and now his both wounds have healed. There were no need for more stitches or even a follow up appointment! His sister had done an excellent job of dressing his wounds daily. Both Hamisi and his sister waved goodbyes to the hospital with huge smiles on their faces. I even shed a tear from happiness. He appears in good health now and is extremely grateful for us at UKUN/PHI for making all this possible for him. I will go for a visit tomorrow and to see his sister Amina; also our patient, for physiotherapy. She is doing well but there are always issues of poverty as they have no income. We need to look into investing in a small business for them. I am hoping we could organize a small welcome home party for Hamisi this week!
Mariam, our bedridden patient, who had a stroke six years ago, paid another visit to Bagamoyo Hospital last week as we had planned. This time family were very co-operative and were all ready to go when I came to pick them up with bajaji. MP looked much improved from the previous week and she was ‘glowing’. The family had fed her porridge and those build up bars as well as all the vitamins and Septrin. We received her blood results and they informed us they were ‘ok’.
The biggest shock was that her CD4 had almost doubled to 288! (Last one 149). That was excellent news and we knew with the daughters that we must be doing something right even we get shouted from the doctors every time we come to the hospital. The daughters said that those doctors just don’t know how hard work is it top look after someone who needs all care.
She was restarted on ARVs and her daughters received some counselling. She needs to be back in two weeks time to take more medicines. Since then we visited her again without informing them advance and we saw that the family are taking care of her better. We bought them some maize to prepare porridge for Mariam and disinfectant for clothes and cleaning. We can reduce our visits now to one a week but we need to make sure to keep her comfortable and support MP's daughters for caring for her.
New Patient ZB:
When at the hospital with MP one CTC patient approached me. Her name is Hadija and we have
helped her previously with supporting to grow her food selling business. Hadija told me that her
mother was very sick and she could not come to the hospital. We with Godfrey went to visit her at
their home in Bagamoyo. Her name is ZB and she has been HIV positive for many years like
Hadija too. They both were unsure how many. Now she has been suffering from Peptic ulcers for
few months, she is also treated for UTI (urine infection) and has really poor mobility. She was not
able to speak clearly due to the abdominal pains. On the assessment she was breathless; respiration
rate 26, Blood Pressure 120/65, pulse 80bpm, and temperature 37 degrees. She was in a lot of pain
and had no strength in any of her limbs. She reported no cough and her chest appeared clear when
listening. She reported pain when urinating and complained of constipation too. The abdominal pain
was severe when eating but she still had been eating. Two weeks ago she went to the hospital and
said doctors gave her one saline drip, stopped her Omeprazole – as it was ‘not working’ and gave her
Amoxicillin and Furadantin for UTI. We left her with some Paracetamol and milk and promised to
come back with more medications later. We advised her and Hadija about non acidic diet she should
After doing some research on the internet and asking nurses and doctors from UK, two days later
we went back and took her Ranitidine (stops the production of acid), more painkillers and laxatives
for constipation. I was also advised that she should continue Omeprazole. She appeared much better
than previously and was sitting or her bed eating ugali! Her arms had got better and with a help of
two she could mobilize to the toilet. We gave Hadija half kilo of porridge to prepare for her mum.
We would visit them again after five days.
After doing some more research on the medications; many state that she should be taking others
and more antibiotics to eradicate the ulcer in case it is H.P (Helicobacter Pyroli) e.g. Clarithromycin.
Unfortunately there was one death of a patient in Bagamoyo. He was not apparently one our
UKUN/PHI patients but a relative of our patient Sulemani who informed us about this sick man
MSH (not 100% of the name!). Charles and Godfrey had gone to see him and reported that he
needed a surgery to his arm. When I came back from Dar we went there to see him with David and
Godfrey. The way we found him was horrific; gasping for breaths, spitting blood, severely
malnourished, he looked like he had just been left for a long time. The family reported that they had
had no money for hospital transport ( 2000Tsh= 1 euro) and it didn’t seem right. After quick
assessment we called bajaji and took him with one family member to the hospital. We had to carry
him with sheets and there was diarrhoea all over. Once we got to the hospital we went to the
admissions (there is no emergency department in Bagamoyo Hospital, very common thing in
Tanzania). We put him on the trolley and went passed the entire queue direct to the doctor’s office
and people were helping us to get there. The female doctor started to ask questions and do
paperwork instead of checking the patient. Despite of her ‘bad’ attitude, after ten minutes we were
on our way to a medical ward to admit him. Doctors there told us he had life threatening
Cryptococcal Meningitis (infection and inflammation of brain and spinal cord). The only treatment
for that is IV Fluconazole but it costs 7000Tsh (£3) per bottle and this patient will need fourteen of
them, seven at least. This is a HUGE cost for local people in Tanzania and the doctor explained that
most people die here for that because they cannot afford the medication. The family bought one
bottle (and they did not have 2000Tsh for the hospital transport before!) and we bought another
one. The doctors also told us he had Hypoglycaemia (very low blood sugar). We also bought IV- fluids
including IV-Glucose, Septrin tablets, gloves and syringes (those were the requirement from the
ward.) I promised to come to check on him the next morning and we felt a moment of hope when
leaving with David and Godfrey. However two hours later I got a phone call that he had died, we had
come too late.
As a result of this, we have decided to start a search- campaign next week and find as many old
UKUN/PHI clients as we can; those that are ‘lost follow up’ to avoid something like this happening
again. We need Charles for that but he is away in Arusha. Once he comes back we can start as he is
the only one who possibly knows some of the addresses of our old clients.
I have also made referral form to UKUN/PHI home-based care in English and Kiswahili. I plan to put
them in hospital CTC clinic (for HIV patients) and put it into all the doctors’ rooms with a box to post
them so they can refer patients to us. We collect the forms ourselves and visit the patient referred
to see if they fit our criteria for home-help or help with referrals to a bigger hospital.
For the past two weekends we had four different groups of HIV counselling students from Dar Es Salaam. They were from that same school that David and Godfrey have now both finished. They wanted to do some field work for two days visiting and seeing how the patients live. They also brought many presents for our patients like soap bars and ugali flour, which was very gesture. They visited four families (5 students for each family); Captain, Mariam, Morogoro family and our new patient Zainabu and Hadija. Patients were very grateful for the gifts and were happy to discuss with them about the history of their disease. Many of them were very keen to come back next year to do their field placement with us for three months, which would be excellent news to us!
And finally we have been very fortunate to get new donors! We have our main regular donors;
Debbie and Tarek who keep contributing for our patients care. Now Debbie’s friend Cathy has had
several cake-sales in UK to raise money for us and Debbie’s doctor colleagues donated £100 for us.
We have now also regular donors from Finland and UK donating in total of £30 every month through
‘Every Little Helps’ and we should be getting more of their friends to donate! Also Minna is helping
to find the donors for Abdullah’s school meals for next year. I am still waiting for the email of the
costs for that from GOIG School. We have made a new shoe album with Chanzi to raise money. This
time it also includes a necklace from an artist friend Zakaria. Orders are coming in fast; 6 necklaces
and 12 pairs of shoes sold already!
This coming week two volunteers are arriving; Debbie- ex volunteer and big fundraiser from UK and
Kirstine- student from Denmark. We will have a great team of volunteers for a month. In December
we are possible getting a student nurse from Sweden for two weeks and one of our musketeers
Mathilde will be coming for a month in January. She has become the contact person for Action Aid
Denmark volunteers, valuable work for our future here.
September 30th to October 13th 2013.
These last two weeks at home-based care in Bagamoyo were really busy as usual. I spent half of both weeks in Dar Es Salaam with patient H who is recovering from his operation and the other half with patients here in Bagamoyo. Electric was off for four days last week! President came for a visit and Bagamoyo town wanted to build some streets wider for him. Someone cut several trees over the electric wires while doing that!
Here are the updates of the patients;
It is three weeks now since Patient HT had his operation; double mastectomy in Muhimbili Hospital. I visited him in Mbagala to change his dressings and the wound to his right chest has already healed and does not require being dressed anymore. The left side wound appeared to be septic and had ‘opened up’ a little. He had his follow-up appointment last week in Muhimbili and the doctors advised to re-dress it daily and then come back after a week for few more stitches. HT’s sister was happy to do the dressings at their house and this coming week we are going back to the hospital. Otherwise Hamisi is recovering well; all physiological observations are stable and he is in very good spirits. The pain to his wounds has lessened and he has started to mobilise around the house. He has also finished his course of antibiotics and according to the doctor he does not require more.
Patient S had his follow up appointment in Ocean Road Hospital in Dar Es Salaam and was advised to come back in January next year. He has now completed his full course of radiotherapy for his anal cancer. He reported that his wife is feeling well now too. We will be visiting them this coming week.
I visited patient MF several times and again the family refused to take patient MF to the hospital in two occasions even everything was pre organised and they had promised. We cannot do anything without their consent and it has been very frustrating for us. Last week I and local volunteer David went to see them and we talked to the family about the care of patient MF and their feelings about her care. Patient MF daughters reported that they feel that they have lost their hope for their mum to get better and half of the daughters have left home now and do not involve in her care anymore. We explained the importance of adherence of medication, palliative care and keeping their mum as comfortable as possible. They finally agreed to take her to the hospital with us. I went together with three of the daughters, all in one ‘bajaji’, which is a three wheeled scooter! She got given a new hospital card (family had lost the old one), had her CD4 checked (last result was 149 done in March this year) and had various other blood tests including haemoglobin. She was not given ARVs (Antiretrovirals) yet as the doctor wants to wait for all the results first but she was prescribed Co-Trimoxazole (Septrin), iron, folic acid and multivitamins and was given more creams to her skin problems. Mama Kizenga, patient M's sister was organizing everything for us and also bought some porridge, gave gloves and some packets of supplementary meals (made of peanuts, sugar and fat) that only hospital gets for patients that are malnourished. No wonder I had never seen them before. I asked her for more of those to our other patients but she refused to give me today and told me to come back another week. I guess there is limited stock of them and I was told that they cannot be bought anywhere as they are donated. Patient MF blood pressure is within normal range now. Pressure sore has been static on her hip; no improvement but no worse. I have now taught three of the daughters how to clean and dress it and given them supplies. We will all go back to the hospital next week same time to receive results and adherence counselling for the family. She will possibly given the same ARVs that she had been on previously. The highlight of the week was the laughter on her face when we all (four of us) were carrying her in the wheelchair above our heads over all the too many obstacles that came on our way in the hospital. There was definitely a feeling of hope in the air, literally.
There is nothing new to report with patient CP. He was so happy for Chanzi’s visit on both weeks and we took him for a little walk. He had his monthly hospital appointment and next month he is due his six monthly CD4 test. He had his two showers a week, laundry done, few extra snacks and clean drinking water. Family still do not want to help or get involved in his care. I asked someone to just change his sheet while I was showering him but they refused. His uncle though who is the practising ‘witch-doctor’ in their house asked me for painkillers for his back! I said I thought he was a ‘doctor’ himself with plenty of ‘medicines’.
Giliano and his family are doing better. Giliano continues to use his walker and reported to have improved. TB results for Giliano were negative, which was good news. He still reports dizziness but is eating his ARVs well now with anti-emetics. We are still waiting for results for the baby (for HIV) but she is feeling better from the malaria. The young boy was supposed to be tested yesterday at his home but Charles and the boys decided to do it next week. My Kiswahili is still not good enough to do the counselling pre and post testing.
I should be getting e-pap this week for the father Gillian to build him up quicker. Now we are supporting the family with porridge. The mother never apparently went to the TB test and it seems that she does not understand the importance of it. Need to discuss again and find out what is the issue.
Patient AB got his CD4 results and it was shockingly low 159. We talked him about the importance of medication adherence and nutrition. It could be due to him suffering from TB for the past six months and we hope to get it back above 300 in the next six months. Otherwise he appears really well and keeps asking about starting an education. This week we are taking him to GOIG, which is a school near to Dar (Mbezi) sponsored from Finland. They are happy to talk to Abdullah about his wishes for future education and they can possibly offer free places to orphans. After that we will take him to the beach there so we can have a full fun day out as he has never been out of Bagamoyo.
I will make another visit to Muhimbili with Hamisi and Bagamoyo Hospital with Mariam. We are getting 30 students of HIV counsellors from Dar Es Salaam for Friday and Saturday. They will visit all our clients’ families and make needs assessment and on the second day they will try to fill those needs. Godfrey and David (their fellow students) will be in charge of introducing the families to them as I will be in Dar and Charles is away in Arusha for a week. I will get our pharmacy stock from Dar Es Salaam at the weekend and hope to get reply from the e-pap distributor. It will be the week of celebration for Eid.
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