Daktari Diary

MONDAY 15th Jan 2007
Visit the clinic. Dr Hamza v. busy. Toured building with ‘Injection man’. Some progress with works but disappointing. Took pictures. Ceilings better and some wiring done but still much work to be done. None of the rooms are usable yet, so Dr H’s room and midwife’s room the same, and temporary laboratory in old office. ‘Dental’ room that will be used for surgery not far off completion, but air con is open windows! I discussed possibility of sealed up room with aircon unit but Dr H says not necessary! Personally I would be unhappy about flies, doo-doos etc. during surgery.
Dr H due to visit me 6 pm but at 7 pm I phoned him to hear he was v.v. busy with girl with cholera – more of this later.
TUESDAY 16th 4.30pm
Dr H visits and have good meeting.
He produced list of surgical instruments and Autoclave which I approved, and said I would ring-fence the money for the requirements. (approx £300). However, I said not to purchase these till building ready.
Power cuts continue. Martin Hall assessed the building during his stay and decided a 5KVA generator would be adequate to provide electricity to essential rooms, and obtained a quote for a 4.75 KVA one for £750. (next one 10 KVA for £2000!) I told Dr H that ZAP would buy this when the building is ready, and that he must speak to the electrical contractors and get a quote for necessary wiring so that the generator can plug into one socket.
Usual story of fundi (workmen) coming for 2-3 days then bugger off for 2-3 weeks.
Antibiotics - for children
We have previously supplied. Dr H reports that now he is receiving adequate supplies from Government.
Dressings - bicycle injuries especially.
Reasonable supplies but e.g. gauze in rolls and non-sterile. Discussed sterile packs – Dr H will get quotes. Non-stick dressings a concept that he doesn’t seem to recognise. Dr H has kept record of children and problem doesn’t seem as bad as feared. – 7 cases in 8/52 in children aged 3-14, all minor abrasions only. No fractures. Apparently many children with minor injuries go to Wellness Centre (Ali Baba) where they are treated by Mama Patima and volunteers.
Malaria – excellent – no new cases so only 3 cases in 2007.
Diabetes – 3-4 insulin-dependent cases in Jambiani. Not treated at Clinic – attend Mnazi Moja Hospital twice a month. Insulin sometimes provided, but at times has to be paid for by patient. I said in emergency ZAP would pay but we didn’t want to commit to long-term routine payments.,
Nurses – Midwife Mwatima (ZAP funded) done exams and awaits results. Hopefully will start work at Clinic in about 1/12 time. Wadhifa continues with Nursing College. (Mr P. says he has now paid the requisite amount for Wadhifa’s books, food etc. requested way back in October).
Journals – no progress. Advised Dr H to talk to Doctors in S.Town when he attends meetings and discuss suitability and availability.
Staff Electricity at Clinic. Dr H v. upset as still having to pay bills privately in spite of continued assurance that Government will pay. He has tried to contact Mohammed Jiddawi without success. I said I would try to contact Mohammed myself (feel sure he said to send bills direct to him).
Monday 15th – girl aged 15 contracted cholera, it is thought in village she had been visiting. This village is 12-13 k up the coast and has poor hygiene with inadequate latrines and poor water supply. People often defecate on the ground. There is an outbreak of cholera in this village at the moment and 3 deaths so far.
Dr H did his best with this girl, including I.V. fluids and stayed with her until she died at 3 am. Next day chlorine was poured into the Jambiani latrines in her area, and after our meeting on 16th Dr H was off to talk to her family and neighbours about hygiene measures.
Jambiani (NB. Northern half only) has good piped water supply and wells now v. rarely used.
Public health van toured village Tuesday 16th giving warnings and advising no selling of ‘fast food’ previously cooked, and no sharing and ? other advice,
Wednesday – Pandu says told 3-4 cases in Jam, but I think confused with other village (hopefully!)
No – checked this later and all are now in MFUMBWI – the southern part of Jam village. But they could be gastric enteritis.
(N.B. P and J went away for 2 day break so had no contact with Jam from Thurs – Sat.)
Saturday – 9 cases now in Mfumbwi (southern end of village). Area is isolated – police are there and some Europeans moved out. Medical team arrived and set up Camp where they are treating patients. No mortality. I gave Hamza money for phone. Pandu gave ZAP money for food for the team.
Sunday – Hamza reports patients doing well. 3 been discharged, and 4 new cases. I went to the temporary clinic and was impressed. New modern house connected to Clinic with number of beds (charpoys). 3 patients on I.V. drips and some others just lying down. Staff seemed ‘on the ball’ led by ‘doctor’ from Makunduchi. They proffered their forearm/wrist to me instead of full handshake, for e.g. They have been giving Ciprofloxacin but have nearly run out and will be using Doxycycline. Getting low on I.V. fluids but have plenty of sachets equivalent to Dioralyte. Gave Dr 10,000
/- Tsh for his phone credit. I was impressed too that we had to use a chlorine dip for our shoes on leaving.
Monday – 8.00 am. Dr H visits – been up since 4 am! Says patients doing well. Still awaiting path reports so diagnoses not final. Dr H treated English tourist yesterday for ‘allergy’ who donated 80,000/- Tsh. This has paid for fish to feed the team.
Has run out of kerosene, so gave 30,000/- ZAP funds for supply and another 5,000/- for his phone credit, and said ZAP was happy to help in this situation.
Spoke to M. Jiddawi on phone. V. dispondent about clinic – I think said Contractors have walked away! Says they wont get more Government contracts but that not much help to Jambiani. Promised to sort out electricity payments when Dr H can get to Stone Town. He said he would try to come to Jambiani but he is v. busy. Discussed cholera.
He sounded a little dismissive and seemed, surprisingly, to have little knowledge of it. I gave him an update and hope to discuss it further when we meet. (if we do).
Thursday 7.30 – Dr H visits looking tired and strained. 8 patients still in temporary Hospital – all from Mfumbwi. 1 new one admitted last night – a lady, v. ill. Hamza couldnt get I.V. going because the electricity in the village was off – power cut in village since 11 pm (only on at 2 pm today) Dr H got drip up early this am. in daylight. Still waiting for lab results sent at weekend. Urged him to find out. Janie suggested to Pandu that he get letter from Jaku (who seems to be the only one allowed to enquire) and call at Lab in ST when he goes this pm. Running out of bottled water but Mr Mehta the road contractor is bringing some today! Dr H insists all wells are closed. Supply of chlorine due to arrive today and they will treat all latrines in Mfumbwi. Gave 10,000 for emergency light (torch!) and telephone credit.
Friday – Dr H reports all patients doing well. Results = 7 out of 8 positive for cholera.
Another group 12 out of 13 positive for cholera. (Dont quite know what this other group is)
Sat – Gave further 10,000/- Tsh to Hamza for his phone.
GOOD NEWS – 5 fundi (workmen) appeared at Clinic yesterday and are working well and say that they will stay and finish the job!! Time will tell.
All latrines been treated with chlorine.
Sunday – still approx 2 cases cholera per day.
Monday – Mohammed Jiddawi joined us for lunch in S. Town. Confirmed he had had a go at Contractors and achieved success.
Electricity bill situation sounds pretty hopeless.
Agreed Theatre must be in sealed room with aircon.
Discussion re. Makunduchi Hospital.
That evening Dr. H came plus wife and kids and I reported our conversation with Mohammed.
Hamza told us there are regular outbreaks of cholera in poor areas of Dar, especially after the rains, and people spread this to S. Town via. ferry etc. Two months ago big outbreak in S. Town – of 200 – 300 people and 50 ++ deaths. Poor patients tend not to seek medical help till too late.
Tuesday – Met Dr H at clinic 11 am. He arrived on motor bike looking v. tired. Had been to 3 other village clinics collecting supplies of I.V. fluids and antibiotics, as run out at Emergency Clinic in Umfumbwe. Told me that newly-qualified and ZAP sponsored nurse Mwatima has started work there. Success for ZAP!
2 new cholera patients, one who arrived from Michamvi (?) which has annoyed Dr. H. Handed out spare medicines sent out by Ian Campbell for our use.
GOOD NEWS!! Fundis still working and much progress in Clinic renovations. Persuaded Dr H to plan theatre in ‘Dental Room’ rather than v. small room he suggested. He agreed this room should be sealed and I said ZAP would undertake the work, including aircon unit and sealed window, and he was v. happy about this.
Showed me a large sack of rice leaning against wall given by a ‘Government Minister’ to help feed emergency workers!
Wednesday – 6pm Dr H visits – looking v. thin and tired. 3 cholera patients yesterday, including 4 year old girl v. ill. At 11pm Clinic staff called out Dr H. as couldnt get drip up. H managed to get I.V. and gave girl 1.5L fluids with dramatic improvement in child’s condition. NB. Early I.V. drip with fluids absolutely the key to this disease.
Hotels are helping with food and water, but amazingly Government have given only 20,000/- for food for doctors (about £9 !!) Four clinic staff will have rice only tomorrow, so gave Dr H a further 30,000/- for fish. Told him to contact Pandu after we leave, and he will donate more ZAP funds as necessary.
We had plenty of food at Blue Lagoon and were defrosting a good supply of fish for our supper, which we gave to Dr H. with some tins of beans for him and his family. (We are quite fat enough!)
Later on Wed. Janie returned from lesson in south of village at 8.30. Reported long talk with Vuai who says he has been put in charge of Italian NGO – something like ‘Relief for Children’. This NGO has promised to contribute large sums of money to improve the water supply in Umfumbwe. Vuai says that the pressure is so low here that there is NO WATER TO BE HAD AT ALL between 7pm and 9am. (as opposed to the skuli area which has great pressure) Apparently the source of the water is v.unsatisfactory anyway (but not a well). He was instructing an Italian guy to send a major Report on the situation, with pictures of existing horrors and detailed costings for improvements to his boss that night. Meanwhile, Vuai was in Mfumbwe checking measurements and taking photographs yesterday. He says that they will only have to pay for the materials (huge electricity poles, transformers, pumps, water pipes and conduits, you name it – v.v. expensive) because all the labour is to be done by voluntary workers. He then astounded Janie by saying that they had managed to collect $2000 from the Community, not including hotels etc. When you think how extremely poor the villagers are, this is miraculous, but clearly everybody is aware of the seriousness of the cholera problem and its consequences, especially when you think the long rains are only a month away.
It seemed to Janie that, contrary to what we had been told, Umfumbwe is a place where cholera can certainly thrive, if not start. The people are the most poor in Jambiani, and that is very poor indeed.
Vuai seems optimistic that the work can be carried out and finished by April; he is indefatigable. But definitely the right man for the job – he will email ZAP the whole report in due course.
Thursday – Dr H brings fish to show us – bought with ZAP money for the emergency relief doctors. Says enough to feed 4 people for 10 days. Evening – NO new cases, but worried as has only 1 chlorine spray left (donated!). Agreed 50,000/- TSH for second spray.
Friday – Final visit to Clinic and Cholera Camp. No new cases. Gave 10,000 for phone at Camp and 10,000 for Hamza’a phone. He has NO money. Pandu tells me he also gave Hamza $116 ZAP money at start of cholera outbreak for emergency supplies.
Back in England – following Tuesday. Janie had email from Mrisho at Visitors’ Inn saying the cholera had abated, so assume no new cases since we left.

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