Saying Tchau

It's fairly difficult say goodbye to a place when one feels like there is so much yet to be done. The work is not yet complete, and yet the last grain of sand has fallen in the hourglass. Much of the final week was typical with work and various visits to the hospital or various other places in Beira.

Capellana store

Last minute shopping involved one more run by the capellana store to get some gifts.

One last visit to the Praia Nova Market

One last dinner with friends at Club Nautico.

Here are Deon and a newly made friend this week from Ethiopia working with Food for the Hungry called Halkeno.  His conversion story is impressive as his father was a significant party member in the communist government in Ethiopia.

Here are Lisa (Building Homes for Christ), Ruth Millner holding a little orphan they take home on the weekends, and Denize Versteeg (Brazilian who took us to Senga).

How can you be in Mozambique and not sample clams?  Here's a "measure."

Denize and Deon - great friends!

Chris Millner, son Caleb, and Lisa again.

Final morning at the Millard house with the "meeting of the minds."  I'm not still quite sure who exactly all these people work for - but they're doing brilliant things.  Peter (my boss) PhD, MD, MPH = lots of awesome research on circumcision, ultrasound, HPV, HIV, you name it.  Karine, I'm not sure what all she does but she's French Canadian doing some kind of work getting grants for an HIV vaccine that's in the animal testing stage.  Halkenos, Food for the Hungry, in charge of the HIV program for Mozambique.  And finally our clinical pharmacologist, who is working also on the HIV vaccine that will hopefully be hitting Africa by 2014.  Check out the January issue of Nature for more.

Do you sometimes just feel like you're not doing enough with your life when you're around people like this?  Uh, I sure do.  Good way to leave Africa, I think.  (Your work is nowhere near done!)

Central Hospital Part 2: Pediatric Ward

NICU

Laura really wanted to see the hospital, so my friend Sandra offered to show us the Pediatric ward she was currently rotating through.  We started off in the NICU and then moved on to the nursery.

Nursery

The staff on the pediatric ward were very nice, and while like the rest of the hospital in some peeling paint and older facilities, this was a great in the hospital.

As something I had only read about in textbooks, but will likely see again in the future - this was an interesting case of Burkitt's Lymphoma.

What a sweet little boy!  You can see his left jaw is grossly swollen from the Burkitt's

Touring the malnutrition center

Teaching English // Faculdade de Medicina

Again, I was asked to fill in as a teacher for a few English classes this time for the medical students. Emily Wesson, wife of my American preceptor Dr. Peter Millard, teaches a medically-based English class to the first year medical students. Since the medical curriculum in Mozambique is 6 years, the first year students are on average the age of freshmen in college.

I wish I had gotten more pictures as I taught the students how to do the abdominal exam in English.  Yes, the lesson plan that Emily had written included a narrative of a hispanic patient with a physician in Denver, Colorado - so I felt quite at home teaching the class.  :) 

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The students seemed to enjoy the application of english though we had to keep reviewing: figaro = liver, vaso = spleen as some of the organs are not remembered quite as easily. :)

Yes, my reviews included:  "I Liked Teacher Abbie.  She's nice.  *Hugs hugs*"  And "Thank you Dr. Urish.  -Kisses"

Only in portuguese are "abracos and beijos" (hugs and kisses) a completely normal and frequent ending to correspondence!

Dr. Chris Millner - my favorite British doc (his wife works at the orphanage mentioned in an earlier post)

 I also visited Chris's office near the classrooms.  With a huge servants' heart, he shares this small office as he works in Africa for 2 years.  He will return to being the head of a large practice in London, I'm guessing with a much larger office. :)

Senga: or how the canoe didn't tip over!

The area I'm staying at isn't known in Mozambique for amazing beaches. (Though yes, they're still quite beautiful, so I don't understand how the ranking goes.) So for a day excursion I asked my new friends if they'd like to go to a nice beach for the day. Rio Savani is an area near here known to be nice (but more populated), so they said we should go to Senga which is a little further out.

Deon and Denize are a couple I met here that go to an English-speaking church that I attended a couple times while here. Deon is a South African and Denize is Brazilian. Laura also said she'd like to come, so we drove for a couple hours and then arrived at a little bit of paradise.

We had to walk a ways across some mud and sand as the tide was out...

But even that was beautiful!

Last time our hosts were at this area, their canoe capsized so they took a couple trips to carry us all across safely. 

Our canoe sailors

Deon and I pass over

You can tell just by looking at either end of the canoe that show the rings of a very old trunk, that each canoe is made from a single large tree.  I was told later on that they're passed down from father to son, from generation to generaton.  The handiwork is pretty impressive.

Important things like wintered faces from New York need to be covered

I can see for miles and miles and miles and..

Denize and me

Mirror?

Our canoe folks and locals

Trading spaces...

First sunset!

Another American resident arrived on Thursday - her name's Laura Van Metre and she's in her second year of internal medicine residency in New York City.  Since she came in the same day as my doctor and his wife left for a weeklong conference trip, they let us move into their place near the clinic.   She's got a great Texas/New York/Jewish/Argentinian accent when she speaks in Portuguese - and it's been fun to do further exploring of the area with her while introducing her to my favorite spots before leaving next week.

Jellyfish... clever name.

Estoril Lighthouse, w/metal shipframe in front

Either this boat was aiming for the lighthouse, or someone forgot to leave the lights on.

The best way to cool down from the heat!

Tuberculosis

PPD test

What a terrible disease!  Only 10% of those exposed to this as immunocompetent people actually get infected, but with some much HIV it is far more common in Mozambique.

Side effects/complications of TB include: abdominal TB, Pott's Disease (particularly in children), and along with pulmonary a whole host of extrapulmonary presentations.

Medical: Tungiasis/Matakenya

 Matakenya is the local term for this painful skin condition caused by burrowing fleas that we know as tungiasis.  Locals who even wear sandals are susceptible to what can best be described as larvae pustules that can be anywhere on the foot, and which are self limited but can cause an enormous amount of pain. 

The flea burrows into the skin and the initial symptoms include severe itching.  Later on the flea tries to lay eggs and ends up dying in the pustule of eggs and the body of the flea.  Medical removal involves washing (with some very calloused feet this requires high duty brushes.)  Then using a razor or sharp object the entire flea and eggs must be removed.  Unfortunately this can cause some bleeding, which should be minimized to reduce other pathogenic infection.  Topical or systemic antibiotics should be used.  For this "family" of 3 orphan children and older grandmother-figure we also prescribed an antiparasitic treatment as well.

Medical Monday #6: Orphanage

My favorite british doctor here (not just because between patients we talk about the laws of thermodynamics, nerds unite) Chris Milner's wife Ruth works at an orphanage. He occasionally will see the children there as patients - so I asked to visit as well.

Mozambique is currently trending away from orphanages, in fact, they're in the process of closing them down. It has become clear to the government and everyone else that children do best in families or smaller settings. Far too many deaths occur in the orphanages here from failure to thrive resulting from neglect. Though Ruth did a lot at this orphanage when I visited, the sheer number of children desiring attention and care outnumbered the several staff members. There was a study done long ago in Britain apparently where children were given nothing but food and shelter; and it had to be stopped because children started dying.

I was, and am, still quite overwhelmed with the experience. Even as we entered the hallway, I was surrounded by children that grabbed at every available finger, pantleg, and they all wanted attention. "Tia, tia, tia" (aunt, aunt, aunt) there was a voice on every side. They were nearly all underdeveloped for their age (even with adequate nutrition), and some had other physical abnormalities. A boy about 5 with hearing problems followed me around all morning and would just come and sit next to me grabbing my hand and just smile. Other children already had apathetic behaviors and were detached from playing.

It's hard to describe how I felt around such small children. It made me angry to think of parents who had left them, though some had lost both parents to AIDS. It made me angry to think of the rest of society abandoning them. It made me just terribly sad to think of all the unmet need when all that they asked was for affection.

Sailing Sunday

Emily Wesson, the wife of my preceptor, is an experienced sailor and teaches sailing classes. I begged her to take me out with her as she gave instructions to the owner of a little catamaran. It had been storming before we set sail, so we were nervous it wouldn't be great weather. Instead, just the opposite, there were few winds and the clouds disappeared to blue skies and sunshine. (My sunburned legs can attest to the African sunshine.)

Let me just say, it is absolutely THE best way to see a harbor city. Gorgeous. These are just the shots before we left.

Emily making adjustments as the beach crew watched. :)