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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