October 2014 - Week One - Douglas Grey

Hi Bill and Sonia. I wanted to carry on the tradition of capturing the senses of the experience at Muhimbili National Hospital as part of the AGCT Volunteer effort. Craig Lubbock and I left San Francisco last Monday, traveling through Dubai on way to Dar es Salaam. Air Emirates is a good airlines but a rather chaotic trip with rowdy passengers. Arrived at Dubai at 7 pm and to hotel in Jameriah district (hotel like ship) along beach. Hotels are beautiful and many employees. We went up the worlds tallest building- up to 124 floor and still only 2/3 the way to the top. Dubai to Dar is an easy flight that gets in at 3:30 pm so easy transport to Kalenga a House. It is empty this time of year, with only Hamid, an Egyptian Anesthesiologist here. Jeff Crawford, a fourth year resident from University of Oregon came on Saturday.
First weekend setting up the house for our stay including stocking the kitchen, getting Tanzanian schillings, and getting the phones to work. We learned several things, not necessarily in any order. First, there are roughly three tiers if grocery stores, depending on what you want. The one down Kalenga is fine for most of what one needs to do basics. We bought coffee maker for kitchen and coffee for breakfast now enjoyable. The next tier is downtown in VIVA building, across from Serena Hotel. Has better quality but limited inventory.  Most complete is Village Market on Haile Selassie Blvd on peninsula. Expensive but have fresh produce and extensive inventory.
Schillings are easy to come by and ATMs are everywhere but occasionally they run out of schillings. Changing $100 bills us also good, but can take time. Exchange rate is 1675:1.
The phones are all working now and we discovered two things: SIM chips that are unused for several months cannot be reactivated; and using minutes (in a plan) instead of schillings is more cost effective.
We have had very discussions with the two MUHAS surgeons who have been AGCT supporters for residents: Ali Mwanga and Larry Okoko, absolutely wonderful people. They put on a multidisciplinary meeting yesterday about two issues: blood transfusion resources, and case cancellations. They had two residents who had used these themes for their research, and will be presenting these at COSECA in a few months. They wanted a "low energy" [read unemotional] discussion to improve their programs. There are many obstacles to the delivery of care, but they led the discussion masterfully.
Today we had morning report, met many of the surgeons and residents. There were fifteen patients presented, the residents were grilled, and done patient care decisions made. The staff is committed to excellent care and it came through. We learned much of the practice of surgery in a resource-constrained environment.
We brought lots of surgical supplies for teaching surgical skills and hope to put on labs for residents beginning next week.
Tomorrow is idle. There is one OR that needs a cardiac monitor to function and there is still no end to this. I am looking on eBay and working with the Biomed engineer to try to identify one .

In finishing, it is a privilege to be here. Yes it it inconvenient and challenging, but the people make it worthwhile.

Cheers. Doug