Spent the morning at CCBRT's fistula clinic, trying to counterbalance my surgical time with a little straight-up medical experience. Dr. Robert (the surgeon who struck me as a bit of a curmudgeon last week) is the presiding physician at the Tuesday clinic, assisted by a very kind nurse whose nametag is always, always backwards. I will have to learn her name by sneakier means.
I arrived just as the two of them were making their way through daily checkups for the 25 or so women currently in the ward as inpatients. Some women were waiting for surgery, but most were recovering post-operation; turns out Dr. Masemga made it through an impressive 16 repair surgeries during his visit last week. The checkups were pretty quick - as Dr. Robert quipped, "We have really only two words in this clinic: 'Well' and 'Dry'." True story. The nurse wrote that phrase down for every single post-surgical patient.
The ward is a pretty peaceful place, save for the blaring television in one corner. (Everytime I've been there, it's showing some sort of American music video channel. Beyonce has fans everywhere.) The recovering women sleep and rest and occasionally shuffle around, carting their catheter bags with them in plastic tureens. I did note a rather sweet scene near the ward door, where a patient was sleeping with her little infant curled up alongside her. Every so often, it seems, babies who get stuck in labor do make it through OK, even if mom's a bit worse for wear.
With all inpatients seen to, the clinic for new arrivals began. A group of women had assembled outside Dr. Robert's office wall, waiting patiently on the outdoor bench until he yelled their names through the window shutters. (HIPAA would be aghast.) The clinic was rather surprising for me in terms of clientele: Although women are referred to CCBRT from all over the country for reason of suspected fistula, only one woman of the seven or eight we saw actually had a fistula. A few had natural incontinence due to various causes. One seemed to have had a botched earlier surgery that had become problematic (the woman herself wasn't sure if she'd had a surgery and had to ask her husband - gives you an idea of how much physicians in this country actually explain things to their patients). Another woman was actually a nun, who'd had to undergo surgery for an iatrogenic fistula after doctors accidently poked a hole in her vaginal tissue while trying to remove a bladder stone. Extraordinarily bad luck, really. You'd think a nun, of all people, could avoid worrying about fistulas.
So lots of significant and quality-of-life-impinging health problems, but not particularly problems that the CCBRT fistula ward is designed to solve. And of course CCBRT itself is not designed to be a general care hospital. If you don't have one of a rather short list of conditions, there's no one there able to take care of you. Unfortunately, referrals are pretty thin on the ground in Tanzania; the woman with the botched surgery, for example, was simply told to go back to wherever it was that she'd been orginally treated. (I hope her husband remembers, at least.)
Dr. Robert seemed to warm up to me a bit as I asked questions, so I've been invited to next week's clinic as well. (Hoping to learn a good Swahili phrase for "It's ok/Don't worry/Try to relax" in the interim; Dr. Robert's style of pelvic exam, where he mostly ignores the woman and certainly doesn't warn her about what he'll be doing, seems to cause a bit of understandable anxiety in the clinic patients.) The recovery period for fistula surgery is usually about 14 days, so I'm looking forward to seeing the patients I saw in surgery getting to go home.
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