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.
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. :)