Haydom Documentary: Life without Care

Life Without Care is a documentary film project centered on Haydom hospital in remote central Tanzania, 200 miles from Arusha, the nearest large town.  

To get involved or to help Haydom hospital, please go to "Donate to Haydom Hospital"

To help Dr. Theresa, please go to "Donate to Dr. Theresa"

Haydom Hospital: Facing Life Without Care from Skyship Films on Vimeo. 

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A Spikey Friend

 

“Some people talk to animals. Not many listen though. That's the problem.”
A.A. Milne, Winnie-the-Pooh  

As a few people already know, I went on Safari (a blog post to come) and had a chance to see some of the wondrous creatures living in Africa. However, one of my favourite animals that I've met on my African journey, lives a little closer to home. In fact right outside the front door of Family House 4, in Haydom.

Henry is an African Hedgehog, and an honorary member of Family House 4. He has been with me since I first arrived in Haydom over 5 weeks ago and has remained despite some challenges. Henry is not much of day-person and prefers to party at night; usually starting off with some fine-dining of bugs and plants around dusk. Although, friendly he largely likes to hang out by himself, and until recently he was very camera shy.

At the start of this week something happened that would turn Henry's whole world upside-down. One day whilst he was out (presumably at one of his other lodgings), a bunch of local human's decided they needed to demolish his careful crafted home to get access to a blocked drainage pipe. It was pure devastation, his home was annihilated in a matter of minutes by picks and shovels, never to be seen again. How does a hedgehog prepare for such wanton destruction.

Later that night Henry returned to what was once his home, staring across the barren red tanzanian dirt. Nothing was left, yet for him, there was now nothing left to lose. He did not run away, he did not hide, he continued on, because he had to.

It was on this night that we found Henry outside, alone, looking bare without the grass and scrub usually covering him. Amin (another medical student) scooped Henry up. Henry adopted his traditional ball defense position, leaving only a small part of his face exposed. For although we were already acquaintances, hedgehogs can never be too sure if you are friend or foe.

And this was how Henry had his first picture taken, barely fitting in Amin's hands. We merely captured a moment of this little hedgehog's life, yet it's a moment I will at least hold on to.

 
If you find hedgehogs interesting or want to find out more about Henry, you can look up Four-toed Hedgehog or Atelerix albiventris.

If you're coming to Haydom and stay in Family House 4 make sure you say hi to Henry.

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A Warm-up Climb: Mt Hanang

Keep close to Nature's heart... and break clear away, once in awhile, and climb a mountain or spend a week in the woods. Wash your spirit clean. John Muir 

 
Out of the many things to do whilst staying in Haydom, climbing Mt Hanang should be on ever visitor's to do list. The Mt Hanang trek is often used by many as a warm-up climb to Mt Kilimanjaro. However, Mt Hanang is not merely a warm-up trek, it readily offers up its' own unique scenery and experience.

A bit of information about Mt Hanang. Mt Hanang is the fourth highest mountain in Tanzania at 3,418m. It is located in the Manyara region, with the town of Katesh lying at it's base. Tours to Mt Hanang are currently organsied by Elisha (who nearly everyone meets on the first day) in Haydom.

Getting to Mt Hanang
Myself and four girls (two Danes and two Norwegians – and yes I'm a lucky man) left from Haydom on a friday afternoon at four to begin our journey to the town of Katesh. The drive takes roughly 2 hours, and is actually in my opinion, on one of the better roads in Tanzania. Our driver was Anom, who works as the information officer for the hospital. You'll find in Tanzania, everyone has a second business, a farm or something. In fact, the hospital's semi-retired radiologist Dr Naman even owns a bar, simply called Dr Namans. But I digress.

The Trek
The next day, the team consisting of myself, Thea, Anna-sofia, Christine, Anne-kine and Elisha (our guide) got up in the early hours of the morning (5:30am) in preparation for our climb. Traditionally, the car takes you from the town of Katesh to the start of the climb at 2000m above sea level. Unfortunately for us it had been raining the whole night before, which meant that the roads where largely impassable. So we started a bit lower, with an extra hour of walking time, before we even reached the starting point.

From there it was a day of progressively climbing up hill, with sunshine, rain, fog and everything in between. The fog was particularly beneficial in the morning, as it helped not being able to see how far we had to climb up. On the way up a few of the team members did suffer some mild symptoms of Altitude Sickness, so be warned. Roughly 6 hours after starting our walk, we finally reached the summit, and enjoyed the spectacular views that were given to us.

The trek is a mixture of climbing through forests, low lying scrub and rocky outcrops. There aren't many animals, but the scenery is always offering up something new. The difficulty of the climb can be quite variable, but is definitely made more challenging if there has been recent rain. No mountain trekking experience required, but you should be reasonable physically fit.

That is a short summary of my Mt Hanang experience.

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Swahili 001 - The Essential Basics

To get the most out of your time at Haydom Lutheran Hospital (HLH), I would recommend learning some Swahili. I feel it's not only important to be polite, but also to embrace a key part of Tanzania culture. Not to mention as you progress it will help you on the wards.

For this lesson we will start off with some basic greetings, and phrases that any traveler to Tanzania should know. All the material I've either learnt during my stay in Haydom or picked up from various books. You might notice that what I have here occasionally differs to what you read elsewhere. This is because I'm largely just presenting the most simplest way of saying things. So this is basically a Crash Course in Swahili.

Ndiyo
Yes

Hapana
No

Greetings
Hello. (to one person);
Hujambo (response: Sijambo – I'm fine)

Hello. (to a group) :
Hamjambo (response: Hatujambo – We're fine)

Hello to an older person or authority figure.
Shikamoo (shee-kah-moh) (response: Marahaba).

Hello to people you know well and generally younger people
Mambo (response: Poa (cool), Poa kichizi kama ndizi (crazy cool like a banana) )

In more formal situations you should add titles when you are addressing people.

For examine saying hello to a male you can say;
Hujambo, bwana? (Bwana = sir, Mr, gentlemen)

For females you can use either;
Bibi or Mama. Mama tends to be more commonly used in Haydom.

Kwa heri
Goodbye

Asante
Thank you

Asante, sana
Thank you very much

Karibu
Welcome, come in, your welcome

Karibu sana
Your very welcome.

How are you?
There are a number of different ways to say how are you. Here I've listed the most common ones. Also note that you can often just say Habari, to ask how are you.

Habari Gani?
What news?

Habari ya asubuhi?
How are you this morning?

Habari ya mchana?
How are you this afternoon?

Habari ya jioni?
How are you this evening?

Nzuri, asante.
Fine, thank you.

And you?
Na wewe?

Tell them about you
Jina langu ni …...
My name is …....

Ninatoka …... (e.g. Australia)
I come from …..... (e.g. Australia)

Mimi ni Australian
I am Australian

And the questions they will ask to find out more about you.

Jina lako ni nani?
What is your name?

Unatoka wapi?
Where are you from?

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Evidence Based Medicine Coming to Haydom

Evidence based medicine is the cornerstone of how we are now taught medicine and it's coming back to Haydom.Yes, I was a little misleading with the title, but I'll explain why in a second.

At Haydom Lutheran Hospital (HLH), where possible interventions are based on guidelines, however due to the lack of resources and staff education levels and availability of doctors, evidence-based medicine is not always practiced. And I think the key to practicing evidence-based medicine is continuing education.

This is where a new exciting initiative comes in. As of tomorrow we are running education sessions every Thursday (typically lead by the expats) for all the local interns and doctors, as well as the foreign volunteers. This a great chance for information exchange to occur between people, who have come from all over the world. It also opens up the information (that we often take for granted) to the local doctors.

Systolic Heart Failure
So for the first session we are taking a look at Systolic Heart Failure.

The paper we are using as pre-reading is;
Systolic Heart Failure by Dr John McMurray in the NEJM (2010)

We are also using ProfessorEBM's module on Heart Failure to guide the discussion.

WHERE YOU COME IN
Considering my involvement with FOAM back home, I thought it would be interesting to see if we could get an asynchronous discussion happening every week on twitter as well. Bringing the collective wisdom of even more people to this hospital in remote Tanzania.

So for now I've come up with the hashtag #HaydomJC (e.g. Haydom Journal Club). If anyone comes up with a better one let me know.

Below I've provided an overview of some of the key points of the article and additional information concerning systolic heart failure for those who don't have time to read the article.

AETIOLOGY

• Coronary Artery Disease (cause of 2/3)

PATHOGENESIS

1. ↑Afterload – due to ↑pulmonary / systemic resistance + ↑volume
2. ↑Contractility - due to SNS stimulation
3. NaCl & H2O retention – due to SNS and RAAS
4. LV remodelling – hypertrophy, dilation, fibrosis

INVESTIGATIONS

• Blood tests – FBC, LFT, urea, electrolytes, cardiac markers, thyroid
• ECG & CXR: Largely insensitive, but can provide useful findings
• Echo: allows confirmation of diagnosis and information about the heart
• Cardiac MRI: useful in difficult cases

TREATMENT
Lifestyle

• Exercise
• improved functional capacity and quality of life in patients
• Salt Restriction
• often recommended
• little evidence

 

Pharmacological

• Diuretics
• For relief of symptoms
• Loop diuretics should be given to patients with fluid overload
• ACEi
• Enalapril, Captopril, Perindopril, Lisinopril
• reduce ventricular size, increase the ejection fraction modestly, and reduce symptoms.
• Angiotensin-Receptor Blockers (ARBs)
• Irbesartan, Losartan, Candesartan
• similar effectiveness to ACEi, but more expensive
• Beta-Blockers
• Non-selective: Propanolol
• β1-selective: Atenolol, Metoprolol
• Aldosterone Antagonists
• The addition of an aldosterone antagonist should be considered for any patient who remains in NYHA class III or IV despite treatment with a diuretic, an ACE inhibitor (or ARB), and a beta-blocker.
• Hydralazine and Isosorbide Dinitrate
• Studies indicate that those of African descent respond more effectively to hydralazine–isosorbide dinitrate than Caucasian patients.
• Pneumococcal and influenza vaccinations are recommended.

Surgical

• Implantable Cardioverter–Defibrillator
• reduces the risk of sudden death in patents with left ventricular systolic dysfunction
• indicated for secondary prevention
• Coronary revascularisation
• Valve replacement / repair
• Cardiac Transplantation

Image Reference: Heart by Guga85

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An African Sting

There is a thin line that separates laughter and pain, comedy and tragedy, humor and hurt.
Erma Bombeck 

I know some of you may be wondering if I actually do any medicine at Haydom Lutheran Hospital (HLH), but don't worry I do. Up in till now I've largely steered away from telling cases from the hospital, and I'm not about to start. Instead I have a little story to tell from yesterday, with some added education.

If we start right back at the beginning, yesterday felt like the first actual normal day for me in Africa. I started the normal routine of practicing medicine at HLH, with the minor change that I had moved from General Surgery to ICU. But alas, you can not have any normal days in Africa.

In the afternoon, a group of us consisting of myself, Amin (Medical Student from the Netherlands), Tea and Anna-sofia (two Danish Medical Students), thought it would be nice to go for a walk around the sunny hillside of Haydom. Having run the route several times by myself, it was nice to finish off the day with a relaxing walk with a few of the others. On the way through the town we met some local kids, who as always seem to have great fun checking out the Mzungu. There was even a little girl who ran up to each of us, just to touch us like we where some sort of good luck charm. Two of the kids followed us on our walk past the airport, until even they sped off on their bikes.

It was then that something strange happen. The kids quickly semi-crashed/jumped off their bikes and started doing what looked like to us weird dances and running all over the road. Having just talked to them a little, we thought this was odd, but couldn't help laughing, thinking that they must be doing some funny local dance thing.

So at this point just imagine a few happy Mzungu going for a walk and seeing some kids do a funny dance. We were in ignorant bliss. We were ill prepared for what was about to happen, and in retrospect we should of gotten right out of there.

But we didn't turn back. No, for we thought everything was fine until we started to hear this buzzing sound. Our ears pricked, we turned to look at each other, and a sudden realization of what we had stepped in to and what the kids had been doing only a minute before.

 An African Bee Swarm

 

African Bee via Wikipedia

Now for those who know little about African Bees, let just say they are very similar to European Bees, just add an extra dose of aggression and about 50 more of them. They are quick to perceive a potential threat, send out more bees to any one threat, and follow victims for a much greater distance. For victims is what we were about to become. Just like the kids we had seen earlier, we ran all over the road, sprinting like most of us had never done before, just to try and shake these bees. Being persistent little Bees (not to mention venomous) a collection of them followed us a distance well over 500 metres. And whether we liked it or not, the outcome was fixed the moment we didn't decide to turn back when we saw the kids acting strangely.

Fortunately, for us we suffered only a total of 6 stings being the four of us. Somehow I don't think the kids were so lucky, and I can only hope they didn't get swarmed to death.

Bee Stings 
So to make the most out of this experience, I thought I should at least impart some medical knowledge about bee stings. For anyone who seen my Medicine in Small Doses series over at IVLine.info, I'm going to use a similar format here.

The most important thing to remember with bee stings, is that you can have different reactions each time (from mild swelling to anaphylaxis), and more stings (i.e. more venom) can lead to worse symptoms.

Clinical Features: 

• Nausea, vomiting or diarrhea 
• Headache 
• Vertigo 
• Feeling faint or fainting 
• Convulsions 
• Fever 

Management: 
In general, management can be reasonable conservative for the vast majority of bee stings.
The following is reccommended;

• Remove the stinger 
• Wash the area with soap and cool water 
• Apply hydrocortisone cream or calamine to the site
• Take an oral antihistamine
• Elevate the extremity if swelling is increasing.

 Lessons Learnt

1. No such thing as a normal day in Africa, each day is full of surprises. Arguable there is no such thing as a normal day back home, we just forget to appreciate the little things that happen around us.
2. Bee stings hurt.
3. There can sometimes be a thin line between laughter and pain, and it's important to remember that each of us draws the line at different places.

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Taking a Step Back in Time

Yesterday is gone. Tomorrow has not yet come.
We have only today. Let us begin. ― Mother Teresa

At Haydom Lutheran Hospital (HLH), there is a set routine to things. You get up in the morning, go have breakfast, then go to the doctors meeting at 7:30am, followed by Sala (which is a morning prayer and general announcement session attended by all in the hospital), then the radiology meeting and finally clinical duties (which typically starts off with ward rounds).

At Sala newcomers and guests to HLH introduce themselves. I did this last Monday and I basically just said who I was, where I was from, how long I was staying and what department I was going to be working in. If you're really organised or already know a lot Kiswahili, it makes a really good impression if you say it in both English and Kiswahili.

While there is a large overarching routine to things, a lot of this falls away at the immediate practice of medicine. Having done several ward rounds now I can honestly say they have been of variable experience. One the fundamental issues is a lack of organisation at times, which seems to make ward rounds last a century. Secondly, rather than a single nurse in charge of a patient there are multiple. This might sound like a good thing, but the problem is each nurse only does one task (e.g. insert a line, be at the ward round, send for x-ray), and they don't always communicate with each other or the doctors. But for now I play the foreign medical student role and see how things play out. No one likes being told what to do, and if it works for them who am I to say otherwise.

In my first observed operation at HLH, I was able to get a reasonable picture of how all operations are done at HLH. We were very fortunate to be in the lucky theatre with a pulse oximeter (other vitals were just done at the beginning). I couldn't help remembering from SMACC whilst I watched, that the pulse oximeter is the world's first time machine, taking you a step back in time.

Some quick facts of life with Surgery at HLH;

• Typically no vitals. BP cuffs work on a hit and miss basis.
• Nearly everything that can be reused will be reused (e.g. ET tubes).
• Saline is produced on site.
• Anaethetists are not Doctors, but trained technicians. They are still very good at the job, considering they often have to deliver drugs and manually ventilate at the same time.

Our time machine came into play later in that first operation. In HLH oxygen is provided to patients during surgery, however since there is only one machine that makes oxygen, up to four patients can be plugged into the same box simultaneously. During our operation the patient started desaturating (/was already desaturated), and we had to problem solve. Ventilation was all good, patient was not losing any blood, and probe was correctly attached. So next step was for the newbie medical student aka me to do, go clamp off the oxygen lines to the other patients so that ours could get more. Our patient steadily recovered and it was then my task to go tell all the other surgeons that we had cut oxygen off to their patients (as far as know no once suffered an adverse consequences).

I expected that my time Haydom would take me into a different world of medicine and clinical practice. As often is the case though your preconceptions, can differ from reality. There were aspects, I could not anticipate, and scenarios that I thought would exist, that have not yet materialised (and I doubt will). I thought working at Haydom would be like taking a step back in time. However, I now think it's something rather different, it's about going back to the basics. Sometimes doing things there in the moment, not knowing how it's going to play out further down the track. Many people doing the best they can, with the limited resources available, to make a small difference.

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Happy Easter from Tanzania

The Bible tells us that Jesus Christ came to do three things. He came to have my past forgiven, you get a purpose for living and a home in Heaven - Rick Warren

Just a short one today, to say Happy Easter to everyone I know around the world.

I'm currently, relaxing in Meru House Inn in Arusha which I would recommend to all travelers. It has all the basics like hot water, a bed and wifi. Plus there is breakfast each morning.

We don't have any Easter Eggs for tomorrow, but somehow I think we will survive.

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The Odd One Out

We boil at different degrees - Ralph Waldo Emerson

Like this sunflower in a field of maize, being in Africa can make you feel like the odd one out. I would not characterize this as a bad thing, if anything it adds another dimension to your experience.

On my first day at Haydom, I met a large number of the other volunteers, medical students and guests at Haydom Lutheran Hospital (HLH). Unsurprisingly (at least to me), I was something of a novelty. Where as most of the volunteers are from Europe (especially Norway), here was this lone Australian. Not a single person knew where I was from without me telling them. First I was English, then American (someone even spread a story round that I came from a ranching family in Texas) and all sorts of places in between.

The Dongobesh Experience
As much as I was a novelty to the HLH community, as a foreigner (Kiswahili: Mzungu) you stand out in general in Africa. On my second day in Haydom, the Egenberg Family (Signe, Art and Lars) offered for me to go with them to visit some of their friends in Dongobesh. However, the car only had space for four and there were six of us going.

What were we going to do?

The answer was simple, two of us would ride in the tray-back/trailer of the truck. The two lucky volunteers for the first part were myself and Lars, as we were the youngest. So we set off for our two hours journey to Dongobesh, holding (or clinging) onto to the truck's rollcage.

As would come to no surprise too many, the roads were rough and full of holes. And so if you ever find yourself in the back of a truck, on dirt roads anywhere in the world, my advice would be stand up as much as you can. This saves you a lot of pain down the track. The downside is that you might get flipped off the back of a truck if you hit anything. So weigh up the pros and cons.

So here we were, a pair of Mzungu on the back of a truck; and quite possibly the oddest thing around. As we drove along the road, through towns and farmland, people would point, wave and look with almost a sense of shock. It's not uncommon for many Africans to ride on the back of a truck, but clearly Lars and I brought a different aspect to a common thing.

In Dongobesh, we met the Egenberg's friends, who are both highschool teachers (one teaching English, the other Kiswahili). It was at their house that I had my first family cooked meal in a Tanzanian household. And what can I say other than that the food was superb, and was all from produce (e.g. Icrops & animals) right in their very yard.

Whilst I was at their house, their kids inevitability caught a glimpse of my iPhone (I was using it to take photos). Being curious little critters, they wanted to look at it, which I happily obliged. The two boys loved it and were constantly battling over who's go it was to use it. The most amazing thing I saw was that, a four and a seven year old who had never seen a touch screen phone before, who couldn't speak or read english, pick an iPhone up and within the space of 30 minutes know who to navigate it. A win to Apple I guess for intuitive design. Somewhat to my angst, the only game I had on my iPhone Zombie Highway, which basically involves running over and shooting Zombies. I thought it was probably not a good lesson for young kids that the way to succeed is to see how many bodies you can run over. I'm sure others would argue however, that everyone, including man, woman and child, needs to be ready for a Zombie Apocalypse. 

Eventually we had to say our goodbyes and make our way back to Haydom. But, not before we took a walk through the fields outside of Dongobesh (where the above photo was taken). During this walk, we had the opportunity to see how things had been done for centuries, but also the progress being made towards a better future (the construction of a small dam for irrigation purposes).

The Lesson
Sometimes being the odd one out can be challenging, and leave you of unsure about where you fit in. The obvious truth however, is that we are all different. We each have different beliefs, personalities and perspectives.

Though we may be different, like the sunflower in a field of maize, we share the same soil, the same water, the same energy. We interact with and are molded by those around us. We may be separate in appearance, but connected by nature. For we each have something to add, and our individual oddity does not weaken us, but makes us stronger.

We become not a melting pot but a beautiful mosaic. Different people, different beliefs, different yearnings, different hopes, different dreams. - Jimmy Carter

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This is Africa

Traveling is a brutality. It forces you to trust strangers and to lose sight of all that familiar comfort of home and friends. You are constantly off balance. Nothing is yours except the essential things – air, sleep, dreams, the sea, the sky - Cesare Pavese

Finally the moment you've all been waiting for (I'm an optimist at heart), my first post ever from Haydom, and in fact from Africa.

As with many things in Africa, things happen at their own pace, a pace that can be very different to what you are used to. So after several days of no internet, we have finally got some resemblance of internet back in Tanzania, which has given me a brilliant opportunity to post.

The biggest challenge facing me right now, is how to condense all that has happened into a story, where you as the readers can comfortably reach the end. I hope that the stories I share will both be entertaining, but also impart some lessons I've learnt about traveling and working in Tanzania.

Arriving into Tanzania
Arriving into Dar es Salaam gave me my first lesson, into the pace at which Africa can operate. I waited nearly over an hour to get a visa at the airport (know doubt if any of my family are reading this they would be saying 'I told you so'). Consequently, my first point advice to any traveler to Tanzania is to try and get your visa in advance, it's not worth the wait at the other end.

With this delay in getting a visa and delays embarking the plane I actually ended up missing my booked flight from Dar es Salaam to Arusha with PrecisionAir. These flights were initially booked about a gap of about 2hrs.

Lesson 2: Book enough time between flights.

Of course you could argue that I'm largely to blame for not being better prepared.

However, because of this little mishap, I was more or less thrown straight into another aspect of Tanzanian culture; their friendliness and willing to help. I was helped by many different Tanzanians and eventually got a flight later that night to Arusha with FastJet. Sure there was money involved in this case, but just their approach was outwardly friendly and welcoming.

A quick comment on FastJet as I was supposed to originally fly Precision Air. FastJet provided a good flight to Arusha. The only discernible difference I could detect between FastJet and PrecisionAir is that more foreigners seemed to fly PrecisionAir.

I would like to provide a quick lesson on money in Tanzania, which I also learnt during this experience. They are both quite obvious, but I saw one American kick up a stink (Australian phrase to overally complain about something, where it's probably not necessary).

Lesson 3: If paying in $US expect to receive change in Tanzanian Shilling, often worse than official rates.

Lesson 4: In addition, to this if are going to use $US make sure you have small change (e.g. $1 bills) as many vendors won't accept larger notes. However, the larger notes do get better exchange rates.

Lesson 5: New $US bills get better exchange rates.

Getting to Haydom
Before I left Australia I had an initially planned to take the public landcruiser from Arusha to Haydom. Many of the visitors to Haydom do this and it is one of the most common transportation methods.

The down-side (as others have told me) is that it's a 5-6hr journey in a cramped bus, which has zero suspension and subsequently lots of sore buttocks.

I however, was very fortunate to score a last minute plane flight as a joiner (extra passenger on a chartered flight), with Mission Aviation Fellowship or MAF. The flight was an amazing experience and I got to truly see Africa for the first time during the day. One lake we flew over had so many flamingos all you could see from the sky was a mass of moving pink. That was alive both in movement and also colour.

Joiner Flights cost around $US35 a huge saving. Plus your supporting outreach flights.

On this flight, I met one of the nicest and generous families that I've ever encountered. And they are largely the inspiration for the opening quote, so they well and truly deserve a mention. The three team members of the Egenberg family that I met were Ark (Pallitive Care Doctor), Signe (Midwife turned researcher) and their son Lars (future army helicopter pilot). Signe is involved with setting up an initiative in Tanzania to improve maternal outcomes during labour.

And that's it from me for now with plenty more stories to come, especially featuring the Egenberg family.

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Get Ready for Lift Off

Twenty years from now you will be more disappointed by the things you didn’t do than by the ones you did do. So throw off the bowlines, sail away from the safe harbor. Catch the trade winds in your sails. Explore. Dream. Discover. – Mark Twain

I'm currently sitting in Brisbane Airport at 1:00am waiting for my flight. It's not the most exciting part of the journey, but every journey has to start somewhere.

And realistically this journey started some months ago, though I'm only setting off today. It took a lot of planning/communicating back and forth between Haydom Lutheran Hospital, myself and my medical school.

In all this time, I have yet to answer, why Haydom? Well there are a multitude of reasons, so to prevent myself developing RSI tonight I'm just going to focus on a few. And keep them short & sweet.

1. Experience frontline clinical medicine
2. Develop my skills, but give back to a community at the same time
3. Haydom seemed to have a friendly community and well managed hospital
4. Enjoy a holiday somewhere overseas before I graduate (as students we are relatively time-rich so I thought I would take advantage of it)
5. Climb Mt Kilimanjaro
6. Experience something new & exciting

Interestingly it's also given me an opportunity to try out the blogger for iOS app. Unfortunately I can't see how the posts translate to the desktop, but it's looking good so far on the mobile.

That's over and out for now. Expect the next post to be coming from Dar es salaam or Arusha in Tanzania.

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Blog in Development

The Haydom Health blog is currently in development. Resources will be added as permitted by time. In the mean-time take a look Haydom.com for more information and news.

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Donate to Haydom Lutheran Hospital

Photographer: UNAMID

Do you wish to donate to Haydom Lutheran Hospital? My donation campaign has ended but you can  donate directly to Haydom Luthean Hospital here: http://www.haydom.com/?page_id=24

 

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Haydom's History

The information below comes from the Official Haydom Lutheran Hospital website (www.haydom.com).

 The tsetse fly problem 
In the beginning of the 1950s Haydom was an uninhabited bush. Tsetse flies made the area uninhabitable for people, but the area was fruitful: there was an extensive animal kingdom and dry, but luxuriant vegetation.

Fifty years later, Haydom is a village with one of Tanzania’s best hospitals, schools and education at collage level, churches and assembly houses, stores, guest house and trade, a network of roads that connects the town to a large surrounding area, their own water supply, electricity and air strip – and en elite of educated humans that are engaged in further develop their town and country.

It is the Haydom Mountain that has given the hospital its name. The name “Haydom” comes from the local datog language and has the meaning of “red oxen”. The Detog people needed a name for the surrounding mountains, so that they could tell the others where they had been with their cattle. The mountain was often avoided, as there was said to be a curse over it; the one who took his cattle inn to the bush area around the mountain, could suddenly lose the whole herd. People going up the mountain would also be affected and could catch a fever, headache and dive of in unwillingly sleepiness, tiredness and sometimes death.

The disease was known as the sleeping disease, and made the area remain inhabitable. It wasn’t a curse from forefathers or spirits that haunted the area, but tsetse flies that had settled down in the forest and bushes surrounding the mountain. The solution to the problem was easier than first believed; If you cut down the forest, the flies would disappear as well. And so it was that the Norwegian Lutheran Mission was able to build a hospital at Haydom.

The Official Opening 
In 1963 was the administration of the Hospital handed over to the local church, the Evangelical Lutheran Church in Tanzania (ELCT). The hospital is under the Medical Board which in turn is elected by the General Assembly of ELCT, Mbulu Synod.

After an obvious need to expand, the Lutheran World Federation, OXFAM (UK) and “Brot für die Welt” (Germany) funded the extension to a capacity of 250 beds. The hospital was officially opened by the then President, J.K. Nyerere. Since then, the hospital has expanded with a modern building for laboratory and pediatric ward (Lena Ward).

Today HLH has a total of 400 beds, but most of the time the number of inpatients is more than that. The hospital has been part of the Tanzanian central health plan since the official opening in 1967.

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Where is Haydom

Adapted from image by Peterfitzgerald via Wikicommons

Haydom Hospital is located in Rural Tanzania.

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Basic Clinical Skills

Click on the Tutorials below to view further information concerning the topic.

Clinical Examination

Performing a Cardiovascular Clinical Exam
Cardiovascular exams are used in conjunction with the appropriate history taking to ascertain the likelihood of a cardiovascular disease (e.g. congestive heart failure, arrhythmias, infective endocarditis and so on).

Performing a Respiratory Clinical Exam
Respiratory exams are used in conjunction with the appropriate history taking to ascertain the likelihood of a respiratory disease (e.g. upper respiratory tract infection, asthma, pneumothorax, pulmonary embolism and so on).



How to perform a Gastrointestinal Clinical Exam
Gastrointestinal or Abdominal examination is used in combination with suitable history taking to determine the likely disease process (e.g. hepatitis, gastroenteritis, appendicitis and so on).




An Introduction to the Musculoskeletal Clinical Exam
Musculoskeletal Clinical Exams are used in conjunction with the appropriate history taking to ascertain the likelihood of a disorder within the bone or muscles structures. The two main categories into which these disorders can be split into are Disease and Trauma.

Clinical Examination of the Spine
The Spine (Vertebral Column) serves a number of purposes (protection, muscle and ligament attachment, haematopoiesis and so on) and consequently has a range of associated pathologies. Musculoskeletal examination of the spine focuses on determining diseases and disorders that specifically effect that system in relation to the spine.


How to perform a Neurological Clinical Exam
Another important tool in a clinician's toolset. Neurological Clinical Exams are used in a variety of settings from the GP Clinic to in the Intensive Care Unit. This will take you through some basic anatomy, examination of the upper & lower limbs, and examination of the cranial nerves.


How to perform a Clinical Eye Exam
The eye allows us to observe the world around us, but it can also provide clinician's a window into a person's health. Often neglected and left to those dreaming of working as an Ophthalmologist, students and junior doctors alike miss out on a valuable source of information. Here the basics of the Clinical Eye Examination are introduced including reference to Dr John L Colvin and Dr Joseph A Reich's 35 Golden Rules of Eye Care.


History Taking

A Guide to taking a Psychiatric History
There are some areas like Psychiatry, where taking a good and thorough history can be more of a challenge for a medical student. The purpose of taking a Psychiatric History can split into three main things; diagnostic, to gain a biopsychosocial understanding of the patient’s problem, and therapeutic/psycho-educational.This guide sets out a basic structure by which these goals can be achieved.


Presentation Skills

Clinical Skills
A Quick Guide to ECG
ECG is a valuable tool in a clinician’s diagnostic toolset, however for some it’s just not easy to pick up. Most individuals skilled in ECG have achieved proficiency through practice and exposure, as interpreting ECG in the long term is a matter of pattern recognition. This post hopes to bring things back to basics.

A Quick Guide to Chest X-Ray Interpretation
Chest X-Rays (CXR) are routine investigation in clinical practice and consequently it is important for medical students and clinician’s alike to know how to interpret them. With time and practice, interpreting CXRs will become easier, but first you have to find an approach that works for you. This Guide provides you with basics and a number of approaches to help you get started.

The essentials of Basic Life Support
Basic Life Support forms a foundation level of care for treating patients with life-threatening illnesses or injuries, until the appropriate medical care can be provided. This post will run you through DRSABCD and more.

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About Haydom Hospital

 

The information below comes from the Official Haydom Lutheran Hospital website (www.haydom.com).

Haydom Lutheran Hospital is located in the North of Tanzania, around 300 km South-West of Arusha. In the Mbulu area we are the largest hospital, with more than 400 beds, serving around 300.000 people directly and 2.000.000 as referral hospital.

In the beginning of the 1950s Haydom was an uninhabited bush. Tsetse flies made the area uninhabitable for people, but the area was fruitful: there was an extensive animal kingdom and dry, but luxuriant vegetation.

Fifty years later, Haydom is a village with one of Tanzania’s best hospitals, schools and education at collage level, churches and assembly houses, stores, guest house and trade, a network of roads that connects the town to a large surrounding area, their own water supply, electricity and air strip – and en elite of educated humans that are engaged in further develop their town and country.

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Health Resources

This section will eventually contain a list of useful health resources relevant to Haydom Tanzania.

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Join Us

Have been to Haydom Lutheran Hospital in the past or plan to do so in the future?

HaydomHealth was setup to collate the the initial journey of one medical student to Haydom Lutheran Hospital (HLH). However, the plan was always to provide other volunteers, doctors and nurses with a place to share their experiences as well.

We are always looking for those who have been to HLH and would like to share their experiences with the greater world. If you wish to join as an author or a guest blogger or have a story to tell, contact us at aaron [at] ivline.info.

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Experience Africa

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Volunteering at Haydom

The information below comes from the Official Haydom Lutheran Hospital website (www.haydom.com).

Volunteers & Students 
Every year there are many people visiting or working at Haydom Lutheran Hospital. The most common visitors are doctors and dentists, nurses and midwives, medical and nursing students, volunteers, research applicants, casual visitors and hospital friends.

All visitors are very much appreciated as they make a welcomed addition to our staff and surroundings. If you wish to visit Haydom, please send a request to expats(a)haydom.co.tz. Write your request in English to help our staff. Tell us who you are, how many you are, when you wish to come, how long you are planning to stay and what the purpose of your visit is.

Please send the request some time in advance so that we can make the proper arrangements for your stay at Haydom Lutheran Hospital. Haydom normally splits its visitors into the following categories:

Doctors or Dentists
Someone with a medical or dental degree, possibly with postgraduate specialist training You are registered as a doctor, dentist or medical practitioner in the country where you now are working You want to work in the clinical area as a doctor or dentist while at Haydom Volunteer doctors and dentists have played an important part in the service provided by HLH. We appreciate your intention to do the same and look forward to communicating with you about your plans. To work as a doctor/dentist at Haydom you need to do the registrations and provide the required documents informed about on the “Information for doctors and dentists”-site.

Nurses and Midwives
Someone with a registered nursing diploma or degree, possibly with postgraduate specialist training You are registered as a nurse or midwife in the country where you are now working You want to work in the clinical area as a nurse or midwife while at Haydom Volunteer nurses and midwives have given important service in teaching and in the clinical area at Haydom. They are great resources both in practical teaching or lectures for the local nurses/midwives, and also by giving lectures for the nursing students at the school. We appreciate your interest in similar service and look forward to communicate with you about your plans. To work as a nurse/midwife at Haydom you need to do the registrations and provide the required documents informed about on the “Information for nurses and midwives”-site.

Students
You are a student at a recognized University or University Collage and you are looking for internship or elective, or you want to do descriptive research as required by your School with an attachment at Haydom for gathering of information. HLH has an on-going program accepting medical and nursing students for attachments of these types. Students from other professions are also welcomed to apply for a visit to Haydom. For more information and for the required documents needed to stay at Haydom, see the “Information for student”-site.

Volunteer
Someone who would like to work at the hospital, but don’t have a medical background. Professionals in the field of Finance, IT and Human Resources can be a great addition to the hospital, but other workers are also welcome. You don’t need to be a real professional to support Haydom with the important work. There are volunteers who are joining the outreach program, work at the Child Care Unit (CCU) or they are organizing sport activities for the local community. You can always find meaningful activities and assignments to work with. Read “Information for other volunteers” for more information about required documents.

Casual Visitor
You are someone who wishes to visit the hospital for a short time for some reason You are not a personal visitor of any staff member You do not intend to work or study at the hospital.

Hospital Friend
You are a personal visitor of a staff member at the hospital You do not intend to work or study at the hospital.

Before you make any plans to take leave from your work and family, book flights and turn up at Haydom, please read the pages on our web site and to the necessary preparations. A lot of you questions will be answered here. If you have more questions after this, please do not hesitate to contact us. See the “Contact”-site for contact details.

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Departments

The information below comes from the Official Haydom Lutheran Hospital website (www.haydom.com).

The hospital consists of several clinical departments. Here is information about some of them. For further and more up to date details about each department click here.

Reception
When patients arrive at Haydom, they either go to the reception or to the OPD. The most serious cases from the OPD are also sent to the reception. In the reception the patients are given a medical examination before they are admitted and transferred to the specific clinical departments.

Surgical Department
The surgical department is divided between Surgical 1 (general ward) and Surgical 2. All patients with fractures are admitted to Surgical 2 for pre- and post-operative care. Other patients in need of surgery are admitted to the general ward. Trauma and cancer patients are also admitted here.

Paediatric Department
The paediatric department of HLH is called Lena Ward, this is where the children are admitted.

HIV/Aids Clinic
Patients are not admitted to the HIV/Aids clinic, they come here to get the diagnosis, consultation, observation, registration and free medicine. If the patients are very sick, they are admitted to another ward for treatment. The clinic also arranges large informational meetings to increase the knowledge about HIV and Aids.

Diabetes Clinic
Patients with symptoms of diabetes go to the Diabetes Clinic to get the final diagnosis. Here they consultation, treatment and medication for both type 1 and type 2.

Maternity and Gynecology
Gynaecological treatment and all treatment of pregnant women; labour, premature, ante-natal and post-natal.

Dental Clinic
When patients with teeth problems come to the OPD or another ward, they are given an appointment at the dental clinic. Here they get an examination and x-ray and medication if necessary.

Physiotherapy
The physiotherapy department treats patients upon requests from doctors at the different wards. They help patients from all departments. The patients either come to the physiotherapy department, or the staff members from the physiotherapy department visit the patients at the ward where they are admitted. Because this is one of few physiotherapy departments in a very large area, patients also come to the department from other hospitals. The physiotherapists help patients with gymnastics, rehabilitation, breathing exercises, preventing muscle contractures and starting to move again after lying still for a long time.

Internal Medicine
Medical cases without need of surgery are admitted to the Old Ward for treatment. This is one of the biggest wards of the hospital.

Outreach
The outreach department goes out of the hospital and sets up small clinics. They go to about 27 different locations. The outreach department of Haydom covers a very large area. Some of the locations are outside of the Manyara region and have to be reached by plane. On the outreaches children are weighed, registered, vaccinated and given vitamins. The pregnant women are registered and examined. The clinic also offers free HIV tests and educate people in health and more.

Out Patient Department (OPD)
Outpatients from Haydom village and the area around the hospital come to the OPD to be examined, receive medicine and treatment. The most serious cases are referred to the reception for further treatment at the hospital. The eye clinic, dental clinic and physiotherapy are also parts of the OPD.

Psychiatry
The psychiatry department treats both inpatients and outpatients. The department is divided into three: treatment of outpatients, treatment of inpatients (from the other wards) and Amani Ward were patients suffering from serious substance abuse are admitted for detox and rehabilitation.

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About the Authors

HaydomHealth.org was started to share the experiences of those volunteering at Haydom Lutheran Hospital (HLH). To raise awareness about some of the challenges facing the hospital, but also the heart-warming stories of it's workers, volunteers and patients. Finally to act as another starting point for those interested in volunteering at HLH in the future. HaydomHealth.org is largely informal, and there are many other websites from which you can find information (Official Hospital Site: Haydom.com), so get exploring.

Founder/Editor
Aaron is a final year medical student at the University of Queensland, who is undertaking a 6-week medical elective at HLH from March - May 2013. He started off this blog largely to capture his own experiences, but also to raise awareness of life at Haydom Lutheran Hospital.

Aaron has his own blog at IVLine.info which focuses on investigating and sharing information on public health issues, clinical and biomedical sciences and medical education (occasionally diving into Australian Health Policy issues). He also is a guest blogger on Lifeinthefastlane.com a blog dedicated to providing online emergency medicine and critical care insights and education for everyone, everywhere.

However, if you wish to find him quickly, the best place is on twitter at @IVLine.

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