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Day 2: Tanzania Mission 2015

Mission Diaries: Dinesh Kommareddy

· Tanzania

After catching up on some much needed rest, I woke up this morning well-rested and ready to take on the world. I walked downstairs to the hotel’s dining area where the RWB team would meet everyday for breakfast.

I’ll be honest, I had my fair share of concerns when it came to sampling of the local cuisine. However, I was pleased to discover that there is a significant South Indian presence in Dar Es Salaam, and as a result, many of the dishes I came across were quite familiar to me. Needless to say, I managed to stuff my face every morning. If gaining the Tanzania fifteen hasn’t been a thing, it sure is now. But enough about that—I’ll try to refrain from turning this into a food blog, but there are no guarantees.

We arrived at MUHAS roughly around 8:30AM and were welcomed again by Dr. Lulu. The agenda for today was to meet with the Dean of the School of Medicine (pictured center) and to reinforce the University’s support to improve the quality of training for both equipment technicians and resident physicians alike.

The rest of the morning continued with introductions to various hospital directors and service personnel. I could tell Dr. Gill was very eager to get started with training the residents. We hadn’t even completed the full tour of MUHAS’ equipment facilities before Dr. Gill found a desk and began to review cases.

Sure enough, the residents began to swarm into the room. Let me tell you, Dr. Gill sure knows how to draw in a crowd. It wasn’t too long before all the chairs were take (we might have to think about installing stadium seating for next time). The level of respect these residents pay to Dr. Gill is simply amazing. They were incredibly polite and very motivated to improve their craft under Dr. Gill’s guidance. During the first few cases in which the residentshad to examine an X-Ray, many of them remained fairly quiet perhaps out of nervousness. But, after a handful of cases, the room seemed to come alive while Dr. Gill stressed the importance of possessing conviction when diagnosing patients. Before we knew it, it was already time for lunch.

During this break, the RWB team felt it would be a good time to begin unpacking the several suitcases we brought to MUHAS that were filled with medical supplies.

Dr. Gill even managed to find some time to catch-up on his selfies.

The second half of the day, we were invited to attend what is a called a “Tumor Board”. I wasn’t particularly sure what this meant at the time, but I figured it would be a similar setting to the cases we reviewed in the morning.

As we navigated throughout the hospital, I couldn’t help but notice a foul stench in the air as we approached the classroom. There were many patients hovering around the entrance, but I hardly could give them a glance as I quickly made my way into the classroom with my nose partially covered. Brian, Laurie and I sat among the Radiology residents, while Dr. Gill was asked to sit in the front so that he may help lead the discussions. It didn’t take long before I began to understand what exactly a Tumor Board was.

Each resident was asked to present 1-2 cases of severe malignancies found on a patient’s X-Ray. Having gone through X-Rays all morning where I watched Dr. Gill and the residents diagnose patient carcinomas, I felt relatively desensitized with coming to terms with malignant tumors and consequently, poor prognoses. However, I noticed a frail looking women sitting in the front of the room. It hadn’t occurred to me until after the prognosis was discussed, that the tumor on the X-Ray, belonged to this woman! She just sat there quietly, nearly emotionless, while the residents pointed out every malignancy they could see on the X-Ray. I couldn’t believe what I was seeing.

I simply did not feel comfortable taking pictures from that moment forward, at least of the patients. Every single patient that either walked in or were wheeled into the classroom carried the same lifeless expression on their face. It was as if they already knew their days were numbered. In spite of all this, many of these Radiology residents seemed completely unfazed by these tragic cases. There was even a moment of laughter among some of the residents, which I simply couldn’t believe given the circumstances.

From my perspective, there appears to be disconnect in humanism between the patients and the physicians. It is one thing to see tragic malignancies on an X-Ray, but to put a face to it like what was done in this Tumor Board, it’s indescribable. I was left completely baffled after all was said and done. Whether or not this emotional distance serves as a coping mechanism for these residents, it shouldn’t condone the practice of looking at a patient the way we would an X-Ray.

 

Warning: it’s about to get a little graphic here.

 

I remember a patient who had walked in, and almost immediately afterwards, the foul odor from outside the room had returned. Turns out that this patient’s tumor had gotten so bad, that it penetrated out of her skin and began to rot. That foul odor was the result necrosis—her flesh was dying before our eyes.

 

The last patient we saw walked in with a history of jaw pain. After looking at his X-Ray, I could tell Dr. Gill had seen enough. This patient had a tumor so severe, that it extended from his jaw and into his nasal cavity. When the residents were asked how to proceed, they proposed that radiation was the only option. However, Dr. Gill countered that by doing so, the procedure would render the patient unable to eat and he would likely die due to starvation. Unfortunately, alternative therapies are either too expensive or otherwise unavailable in MUHAS, and as a result the patient was sent out to undergo radiation. Two weeks, was Dr. Gill’s prognosis.

 

Today was a heavy day for all of us, but none more than Dr. Gill. I can’t imagine coming to terms with a patient’s poor prognosis, one after another, and having to look each one in the eye knowing that they wont be here the following week.

 

Today was Dr. Gill’s birthday.

Day 2 Impressions:

Are you from out of town?

During the Tumor Board, I was astonished by the sheer number of patients who presented with tumors so severe, that they were essentially beyond saving. Why would they let it get this bad, some might ask? In the United States, if we even suspect that we sprained a muscle our first instinct is to get ourselves checked out by a doctor. However, think about how convenient that might be for a patient living in rural Tanzania? In fact, the vast majority of the patients we saw at the Tumor Board live outside Dar Es Salaam. How did they get here? Where are they staying in the meantime? How are they going to get back home? Can they even afford to be treated here at MUHAS? Unfortunately, these are questions that couldn’t be answered by the majority of the radiology residents. Preventative medicine is a field of healthcare that is meant to extend beyond treatment. There are several socioeconomic factors that can easily remove the incentive to get regular checkups. As a result, many patients from outside Dar Es Salaam only feel the need to visit MUHAS if it’s a life or death situation. Take a guess as to which end of the spectrum the majority of these patients find themselves on.

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