Palliative Care Home Visits with Happy

 I had the opportunity to join the rest of the pharmacy crew—Shana, Meade, and Kent—on a palliative care home visit excursion with Happy, the social worker, and a couple nurses. We traveled to Image to visit three patients in need of medical and social support. 

Two of the three patients we visited were bedridden. One had been confined to bed for five years due to an unclear condition, while another had recently suffered a stroke leaving their left side paralyzed. The third patient, although able to sit up, was unable to walk due to a recent fall. All three patients had hypertension, yet only one was on medication (captopril and baby aspirin after a heart attack), shedding light on the limited access to consistent healthcare in the area.

A key part of these visits was the presence of Happy, the social worker. Happy took the time to speak with each patient and assess their well-being, ensuring that they had familial support and were being properly cared for. While two of the patients seemed to be receiving adequate care, one patient was struggling significantly. This individual had no food available, and their family was facing extreme hardship. Happy contacted the local church to arrange assistance so that the patient would have access to food. 

At one of the homes, we were greeted by a lively three-year-old boy, the grandson of one of our patients. Wearing a Pikachu shirt, he was a little chatterbox, enthusiastically sharing his dreams of becoming a doctor who rides a motorcycle. His energy and joy were contagious, offering a lighthearted moment on our visit.

Healthcare is not just about medication and treatment—it is about ensuring dignity, comfort, and support. These visits reminded me how crucial it is to approach patient care with a holistic perspective, addressing not just physical health but also emotional and social well-being. 

Kira

Clinical Presentation

 I had the opportunity to present a 15-minute lecture on acute kidney injury (AKI) to Ilula Hospital staff and students. This was given at morning report near the end of our trip.  The session covered diagnostic criteria, significance, causative medications, and disease states leading to AKI. To enhance engagement, I included assessment questions to my presentation as well. 

A highlight was the insightful contributions from Ilula staff, who shared their experiences with AKI management, revealing differences in monitoring and treatment approaches. 

This experience reinforced the importance of continuous education and collaboration in healthcare. I am grateful for the chance to contribute and learn from Ilula’s medical community.

Kira

God first - the rest later

Today was a very emotional day for Cait and me. We went to an AA meeting this morning with Dr. Petro. When we arrived in our jeep, the meeting members poured out of the church and surrounded us with singing. Both Cait & I cried. 

After they introduced themselves, we introduced ourselves and told our stories - both of us had brothers with addiction. Then four members of the AA group told their stories. 

Each story began with “God First!” to which the members respond, “the rest later.” Or “Alcohol” with the response “is powerful, cunning, and takes everything.” Then we all danced with joy. 

by Cindy and Cait

“One of the most significant developments that I’ve seen at Ilula Lutheran Hospital”

That’s how one Minnesota doctor described the presence of a digital health record in Ilula Lutheran Hospital’s (ILH) inpatient and outpatient wards. I spent the morning with Joshua, the head of Ilula’s IT department. He showed me the system and answered all my questions. Then, we toured the facility to see all the computer installations.

 

Ilula uses a system called “CareMD.” Doctors carry tablets during their rounds to enter diagnoses, lab requests, medications and other notes. Lab and pharmacy requests are sent immediately to the respective departments. Nurses have a desktop at their nursing station for entering their information. On the wards, they still to write orders and medication schedules in designated books.

Medical Records registration desk today

 

All departments, inpatient and outpatient, have computer workstations – the wards, the outpatient department, Reproductive and Child Health, dental, pharmacy and lab. The system can generate many kinds of reports. I reviewed a report of the last 26 days with the top 10 diagnoses. Other reports include diagnoses by age and gender.

 

Can you guess what the top 10 diagnoses are for the past 26 days? (1) Other, (2) hypertension, (3 and 5) pneumonia, (4) HIV, (6) gastroenteritis, (7) allergic reactions, (8) peptic ulcer, (9) cystitis, and (10) urinary tract infection. I found the list surprising, as did many of my fellow travelers.

 

The server is protected by UPS to prevent loss of patient data during power outages and surges. A back-up copy of all data is made every evening in case of a larger system failure.

 

Some system capabilities are not yet available. Perhaps the most important is a pop-up indicating the Standard Treatment Guidelines (STG) for Tanzania when a diagnosis is entered. Currently, not following the STGs is the most common reason for the National Health Insurance Fund to deny a claim. If the system to alert the provider at the time of treatment, it would greatly reduce insurance denials.

 

I was impressed when I learned from both Joshua and Ilula’s administrator, Alamu Kikoti, that ILH had purchased the software and hardware from revenue flows. They received a loan and are repaying it from patient revenues.

See the changes. 

Medical Records files today

Medical Records office in 2016

by Cindy

Saturday Clinical Outreach

 Saturday part of our team joined the Ilula outreach group to service a village beyond the last dispensary. Nursing staff,dental providers ,lab staff,pharmacists,and physicians all  went together in 3 vehicles on muddy slippery minimally improved roads. Upon arrival we were provided a wonderful breakfast at the pastor’s house before starting clinic. 

     The clinic is a school converted for the day to a clinic with a building for lab and a provider and a second bank of classrooms for extracting teeth,weighing babies and  seeing medical patients. In about 4-5 hours we saw over 130 patients accompanied  by multiple family members and weighed over 80 babies.Multiple teeth were extracted,many medical patients were seen with multiple outpatient lab tests completed and tens of drugs prescribed and filled. It could have been chaotic but the clinic was well organized,efficient and appeared appreciated by the community. Outreach is usually monthly to this village.

     We received a second generous meal again at the pastor’s house before departure. Our feast consisted of rice ,chicken,greens and beans; more than ample for our adventure home.

     An adventure it was! Little did we know the impact of the steady drizzle during the midday. Our roads turned to greasy,rutted paths that proceeded up and down what now appeared to be mountains! Our amazing driver used every gear on his  4 wheel drive vehicle. We made it up every mountain  and drove ,not slid on the downhill side. We even drove halfway into the ditch to pass a stalled large truck. Just as everyone was breathing again and releasing their  death grips on the vehicle (or fellow occupants) we came to a road jam of stopped vehicles. 2 trucks were stuck uphill including 1 with large,long timber logs straddling the road. Our calm driver got out of our Toyota and walked in the mud to survey the scene. He returned confident of our passage. While maintaining complete control he went into a puddled huge mud hole then into the ditch while barely clearing a tree on one side and simultaneously missing the large logging timbers on the other side by no more than 2 inches. It was the most incredible driving l have ever experienced! Needless to say he received much gratitude and multiple rounds of applause from the Americans. Such is clinical care in rural Tanzania.

      Now for church and a slower day tomorrow.

Alan

      

     

Return to a Dream

 Tanzania has a peice of my heart.

It has been more than a decade since I have been on African soil. The first time I came to Tanzania, I was fresh out of undergraduate school, and undecided on life direction. This trip, I am established in my career as a certified orthotist prosthetist, and am arriving with new eyes.

The last week here in Tanzania, I have relished existing in a learning mindset, following along with Tanzanian medical professionals and my peer professionals from the United States.

Yesterday felt like a day curated for me. I and several others visited the Regional Hospital in Iringa. I and Cait splintered off from the group to tour the rehabilitation unit and orthotic and prosthetics lab!

It was such a distinct shift of energy, for me.

I got to "talk shop" with the Tanzanians for the first time. I got to talk to African peers who invest in the same profession as me, strive to provide the same patient experience as me, celebrate the same patient successes as me and struggle with the same patient care struggles as me.
We discussed clinical strategies for specific diagnoses, material preferences for different devices, troubleshooting for poor compliance.
Stark difference came only in the form quantity, ease of access to supplies facility conditions.

Instantly, I could newly relate to my fellow professional travelers. There is something truly ineffable in sharing time and space, in a foreign land, collaborating about something you are passionate about.

It is such fun to share the spark of shared interest. The spark has more energy when you find it across the world.

Ideas, goals, visions and hopes began to grow in that moment. Contact information was shared.

Engaging with the welcoming community in and around the Illula Hospital has been magic. More adventures to come.

Lala salama,
Katelyn 

RCH Center Nearly Completed

 Shoulder to Shoulder has been working with leadership of the Hospital and Diocese for several years to plan a Reproductive and Child Health Center (RCH). Funding was secured by a generous donation by then Peter J King Family Foundation and many donors to Shoulder to Shoulder who made it possible to “raise the roof” of this RCH Center and projected maternity remodel.  Construction started in June and is now nearly complete.

Our group toured the building on our first day and were impressed by the beautifully constructed, spacious building. There are tile floors, well-built walls, excellent doors and cabinets as well as a modern exterior. It is located near the entrance on new hospital property and is immediately next to the new Mother’s Waiting House where women near to deliver can stay. 

After the RCH Center is completed, planning will focus on remodeling and expanding the Maternity ward. The architect and contractor for the maternity ward is expected to be Mr Maluli, director of FM Talents Partners. We were able to review the plan for maternity remodel with him. He needs to get updated hospital data as a part of revision of the plan.

It was wonderful for me personally meet Mr Maluli after working with him by email for the past 6 months in order  to send funds after approval by the construction team from the hospital and Diocese. The result is outstanding!

Kent