Psych

I have my 'The Mind' (a.k.a. psych) exam tomorrow morning. I did a great job studying over the weekend, but really let things slide since Monday afternoon. That day, I made the mistake of having four Arby's Juniors with cheese for lunch, and followed it up with a Wendy's Wild Mountain Spicy Chicken for dinner (Biggie sized, no less). What followed, was two days of indigestion. I am thinking that perhaps my continued use of my anti-malarial doxycycline has something to do with that indigestion...

To refer to Alanis, I think that I need to get off of these antibiotics. The prescription runs out next week. :)

Anyways, I have also been reading 'Blind Willow, Sleeping Woman', since receiving it on Tuesday afternoon, which has also not been good for my studying. I had forgotten that it was a book of short stories, and not a new novel. I had actually already read a fair number of them in the past, but I am enjoying them nonetheless. With all the psych classes and clinics of the last three weeks, I have a whole new perspective on Murakami's work.

I have also been stuck on a particular song for the last three days: 'Chelsea Hotel #2', by LC, of course.

I remember you well in the Chelsea Hotel
you were famous, your heart was a legend.
You told me again you preferred handsome men,
but for me you would make an exception.

And clenching your fist for the ones like us,
who are oppressed by the figures of beauty,
you fixed yourself, you said, "Well never mind,
we are ugly but we have the music."

Maybe some body-dysmorphic traits visible there...

Bookish

I just got an email from Chapters that they've shipped 'Blind Willow, Sleeping Woman', the latest book by Haruki Murakami. I thought that it wasn't out for another week. Well, I can't wait.

At the moment, I'm trying to make my way through The Maarif again. I stopped halfway through on my last read, as I have trouble dealing with 'second translation' new-ageism. Still, I wanted to finish it off, as I just bought 'Portable Nietsche', and want to get going on it. Fun!

Out of Shape

I went for a run yesterday morning, I think for the first time since the Banff-to-Calgary relay. My quads are really sore today.

Today, I need to exercise my brain. Four days until our psych exam, and so I need to know 50% of the material by tonight, as we have other distractions before Thursday, like an informatics "exam" (a.k.a. quiz) on Tuesday, and more psych clinic time on Wednesday.

I'm off to Tim Horton's to begin my exam prep. :)

Flatliners

On Wednesday this week, I joined up with Magic Pants' and UroVision's dissection group, to replace absent members. Here, we don't actually do dissections in class; instead, we work with prosections prepared by the anatomy professor and a couple of his assistants. This also avoids the problem of obtaining donors; they are quite rare, and needless to say, bodies obtained from foreign sources are not necessarily true donors, if you know what I mean. However, students who wish to dissect can still do so after hours, as part of the dissection club. However, due to limited availability last year, we ended up having to join the dissection group via a lottery, and of course, I didn't get in. Well, with people dropping out all the time, I have finally gotten my chance. The lab is deep in the basement, hidden away from the eyes of all. It was good to get in there; my anatomy knowledge is terrible, so I always felt that this would be crucial to my learning.

In unrelated news, I need to eat less kimchi noodle soup. I had something else to say, but I forget what it was...

The Good

One and a half weeks left in psych, and I'm not back in the groove yet. I should be studying pharm right now, but instead, I just watched 'Blackmail is My Life'.

I wanted to contrast my last few summer posts with something positive. So, I am going to list off some of the best things that happened to me this summer:

• The bats outside of the New World Cinema, in Dar. The cinema is inside a walled compound, of course. I saw a few movies there: 'Poseidon', 'Inside Man', and 'Superman Returns'. An interesting thing about the theatre was, that you would order dinner in the food court, and they would bring it to your seat during the movie. What a concept. But, the best thing about the theatre was the huge flowering tree out at the front of the parking lot. The flowers attracted bats like anything; on the trip there, every branch had a bat on it, with it's long winged arms, crawling, grabbing, stretching, staring at a tall human, digging into the flowers. Amazing to watch.

• Animals in Lake Manyara, the Serengeti, and the Ngorongoro crater. The photo is of a young guy in Manyara, living life to its fullest. I never knew that they put so much effort into brushing the dirt off their food.
  

• Birth. Rococo and I had the pleasure of watching a woman, with no pain killers, give birth to her third child. That was a first for both of us. She was lying there, grunted a bit, told the nurses she was ready, and gave birth right there and then. To see a baby arrive into the world was magical. 'The miracle of life!', I thought to myself. Sure looked easy! What a priviledge, to be there at the moment that life begins for a person, the meeting between the mother and child. When we walked out, we saw the happy-looking father waiting in the hallway. What a smile he had. Rococo, however, was traumatized; she said something about 'screams' and 'liquids'. I have to say, the delivery of the placenta caught me off guard. The thing looked like a watermelon from space. I guess I'd never thought about it before.
  

• The east coast of Zanzibar. Like I said before, it was paradise. What a peaceful hotel, my favourite of the trip. Vibe, Rococo, and I really needed the relaxation, after four weeks of intense ups and downs. Closer to Dar, Bongoyo island was pretty amazing too; so close to town, and yet you feel like you're on Gilligan's Island.
  

• The auto parts market in Dar. It was a maze of 30-cm-wide pathways containing at least one hundred tiny little used-part booths. It was invisible from the street, with the entrances completely unmarked. I wonder how many tourists end up in that place every year. Probably none.
  

• Bananas. I think I had bananas every single day I was in Tanzania. In a related subject (food), seeing clove trees, cinnamon trees, and vanilla vines was amazing too. It changed the way I think about those spices.
  

• Pain au chocolat. In the afternoons, it was nice to head over to 'Épi d'or' for some nice French baking, and perhaps a coffee or a tonic.
  

I guess I should have written this post earlier, when my mind was closer to the summer. Here's a funny tidbit. Somehow, street salespeople always knew we were Canadian, on sight. At the end of the trip, a guy told me how they knew: if a group of people was mixed-race and English-speaking, it was probably Canadian.

Seeing Things

I got new glasses today. I have been trying to figure out how they look. I think that 'classy nerd' is the best description.

My new prescription feels weird, though. Before, my glasses were so scratched, that I saw the world in soft focus. Now, it's all hard edges and solid colours.

The Ugly

I am still really tired from my trip. My coherency for the last week has been weak, at best. Last night, I slept around 11 hours. I need to quickly reestablish a more rigid schedule, since our psych course is but three weeks long.

Anyways, let me finish off my downer posts with some examples of the terrible things I saw while in Tanzania.

• A girl of about 11, who was admitted with abdominal pain. The resident apparently decided on exploratory surgery instead of imaging, and cut her open from her xiphoid to her pubus, leaving a big ugly zig-zagging scar. He found nothing conclusive, save signs of peritoneal infection, and had not yet made a diagnosis. On rounds, he couldn't explain to the head surgeon why he decided to do surgery, why he used a huge vertical incision, that will make pregnancy problematic in the future, nor did he have a differential. A smile and respectuful silence were all he needed to be let off the hook.

• A young boy only a few years old. He probably had malaria, but the resident decided to do exploratory surgery on him, and found nothing. Oh, and he forgot to order a blood smear, so there was still no diagnosis. Again, the resident got away with it. As with the previous case, the resident had basically used the patient for personal experimentation, and if I may simplify the situation, it was 'okay', since the patient was from the lower classes.

• A baby a couple of months old, with pyloric stenosis. The baby was one of a set of twins; we saw them together. The other twin was nice and chubby, a picture of health. The sick twin was much smaller (textbook 'failure to thrive'), with terrible signs of dehydration, with his eye sockets deeply burrowed into his skull. The baby had been in for over 24 hours, and had not yet been given anything for its dehydration. No IV drip, not even oral liquids to supplement the breast-feeding of the mother. The diagnosis was not made by the resident handling the case, who had not yet bothered to take a history, but by the chief surgeon doing rounds. Why was the baby not given an IV? The resident smiled and kept a respectful silence. Why no proper history, and no attempt at diagnosis? Smile and stay quiet, and the problem blows over. In this case, there are three possibilities, as far as I could tell, as to the resident's malpractice: (1) the resident was simply too lazy to examine the baby, (2) the family had not paid a sufficient bribe to the resident, or (3) the resident was simply malicious.
  

• A young woman failing to recover from a hysterectomy. She had had a backstreet abortion, which had resulted in a crisis requiring the emergency hysterectomy. She had been 'doing well', but apparently, the staff had forgotten to feed her for a few days. She was very dehydrated, with tachycardia and severe tachypnea (i.e. she was gasping for breath). From her appearance, I would guess that she was not simply dehydrated, but probably also in sepsis. I doubt she survived. Again, I wonder why she was allowed to fall into that state, and malevolence and greed are at the top of the differential. Okay, that's enough for examples of malpractice (all of those were at the government hospital, by the way, and all offending docs were residents, working under almost no oversight).
  

• A mother with very bad oral thrush, breastfeeding a young infant. This was probably a first presentation of AIDS. The doctor gave her something for the candidiasis, and booked a follow-up appointment, where she would be counselled for an HIV test. Of course, according to statistics, the baby had about a 40% chance of having HIV, as well. Obviously, seeing a young woman with HIV is heart-wrenching; to see a baby with HIV, and knowing they will never know a life without antiretroviral therapy, is indescribable. I saw so many cases of parent and child visiting the local HIV clinic together; I can't begin to imagine what life is like for them. Luckily for them, the world is waking up to the situation, and the HIV clinics I went to in Dar Es Salaam and Arusha were excellent. Still, I don't have a handle on what a lifetime of ARV treatment is like.
  

Well, enough of that. Let's change the subject.

One song by Leonard kept entering my head on my trip, to the dismay of Rococo and Vibe, who were forced to listen to my rough voice:

Un Canadien érrant,
Banni de ses foyers,
Parcourait en pleurant
Des pays étrangers.

Un jour triste et pensif,
Assis au bord des flots,
Au courant fugitif,
Il addressa ces mots:

"Si tu vois mon pays,
Mon pays malheureux,
Va dire à mes amis
Que je me souviens d'eux."

Thanks again to Mr. Cohen for writing a song appropriate to my mood du jour.

Posts from here on out will be more optimistic. :)

The Bad

I'm sitting in class now. :) Psych; it seems like it will be interesting. I spent the last few days readjusting to life at home. I started by buying myself a new razor on Saturday, to reward myself for having survived the summer. I finally tried it out on Monday morning, and man was it awesome. I also hit Nelly's for breakfast on Monday and then Tuesday before class; mmmm.

Anyways, I have also been spending a lot of time ruminating about the summer. As part of the process, I'm currently reading, "Petals of Blood" by Ngugi wa Thiong'o. It's full of all the problems that were so obvious in Tanzania today; the book was written about post-independence Kenya.

I think I've already mentioned how the setup of society in Tanzania was so shocking to me. The education systems and health care systems are set up in such a way as to deny the lowest classes the possibility of hope. Education beyond primary school is priced beyond the means of a large percentage of the population, and health care is another problem altogether.

First of all, let me say that I met a lot of terrific, dedicated doctors there. Docs work for a piddly income compared to anywhere in Europe or North America, primarily out of a drive to help their patients. Our primary preceptor was really inspirational, given the hours he worked, and the skill and caring he showed in dealing with his patients.

However, those docs were primarily working in the private system, where patients are primarily the wealthy: either they are rich enough that they pay for all their health care with cash on hand, or they are lucky enough to have health insurance provided by their place of work (this would only be a small percentage of the population).

The government system, on the other hand, is supposed to be accessible to the majority of the population, serving even the poorest people, with fees waved according to need to pay. (For Canadians, I'd have to say that the system closely resembled the Alberta government's proposed, and abandoned, 'Third Way' of public-mixed-with-private health care.) Great, it sounds like everyone in the country has access to health care, right? The rich get to go to private hospitals for enhanced services, while the poor still get a basic standard of health care provided to them at minimal or no charge, correct? Wrong.

The problems begin with the minimal up-front payment that patients must pay, in order to see a doctor. Typically, this is in the range of US$17; half is to register, and half is to see an actual doctor. This is in the same range as your typical co-pay in the US, or as the now-illegal user fees were for a short time in parts of Canada. That may not sound like a terrible amount to a North American, although even here co-pays are primarily designed to prevent people of lower income from going to see a doctor, thus lowering costs to insurance companies. But, in Tanzania, where your typical lower-class person is lucky to make $50 a month, and lucky to save 1/10th of that, that is a huge quantity of money already. Next, that inital fee doesn't cover any tests whatsoever, which all must be paid for by the patient. So, need a CBC? Gotta pay for it. Need an X-ray? Hope you have another $20. A biopsy? Good luck. Don't have the money? Then, sorry, no tests for you, and a clinical diagnosis is all you'll get.

An expense I haven't mentioned so far is tea money, a.k.a. bribery. Doctors and nurses at the government hospitals are paid very little, and so a system of bribery is well established, with service often being withheld or delayed if the appropriate bribe of a few dollars here, a few dollars there, is not paid. It starts at the registration desk, where a bribe can get your up-front fees reduced or partially waved, continues with the nurses, where a bribe can mean the difference between getting that IV put into your dehydrated baby or not, and finally with the doctors, where a bribe can make the difference between being seen today or tomorrow or next week.

I said that based on need, you could be given free health care. In theory, that's great, but in practice, the system is almost non-functional. Noone was able to explain to me how people could qualify... I suspect that you qualify by bribing the correct people. In a sad twist, financially the best diseases to have seemed to be HIV and TB, where a positive test resulted in free medication and doctor's visits, provided for by foreign governments, pharmaceuticals, and Bill Gates.

I'll finish off this subject in the next post.