You gotta fight for your right to...go to clinic

Good God. I promise to never complain about my commute again, even when it's -17 degrees and I'm trying to bike over the ice to school.

For I have seen the Posta-Masaki daladala on a weekday morning.

It is completely and totally out of control. I've had fairly good luck getting out to CCBRT before via the Posta-Masaki route, but I think before yesterday I've been riding a little after the peak of rush hour. The number of buses on this route is completely insufficient given rider demand, so big groups of people are already running alongside the bus as it pulls up to the Posta station, masses of hands clutching at door frame. People inside the bus trying to disembark have to literally fight their way out - I saw one woman actually get trapped inside the bus by the entering mob, unable to get out the door. As soon as (most) people inside have exited, the door hangers (mostly young men) go absolutely nuts, shoving each other and throwing themselves up towards the door in an attempt to get on board, giving no quarter to kids or the elderly or small women also trying to get in. Particular tenacious teenage boys jump up through the open back windows. A huge chunk of the waiting crowd is always left behind (usually those unwilling or unable to shove), hoping to wedge onto the next one. It took me three tries to board a daladala yesterday (I think the trick is to come at the door at an oblique angle). It'd be funny if you didn't have somewhere to be, but if I had to do that everyday on the way to work I'd go crazy. Or I guess maybe I'd start shoving.

But I finally made it to CCBRT hospital again in the morning, probably for my last visit. (Though maybe not - I feel rather welcome and wanted at this point, so much that I'm considering visiting on the day before I fly home. The nurse gave me a hardboiled egg yesterday! Nothing says appreciation like a hardboiled egg. We'll see.) I arrived mid-ward rounds again. Dr. Robert greeted me by announcing that several women were leaking urine that morning - he termed it a "disaster" but didn't strike me as that concerned. Later patient file review seems to indicate that leaking is not that uncommon for fistula patients that later experience full recoveries. Ward rounds are kind of funny: Dr. Robert kind of acts like a sardonic uncle figure to all the patients. At each patient's bed he cracks jokes, mostly making fun of her, and she and all the other women giggle. It's like The Today Show for the fistula ward.

After ward rounds, Tuesday clinic commenced. Last Tuesday I was surprised that only one true fistula patient showed up; this time, there weren't any true fistulas at all. Or at least no clearly obvious ones. But I do think that the kind of women who end up at the clinic give a sort of representative snapshot of life as a woman in Tanzania. At one end of the spectrum was an 80-year old woman who arrived with her two daughters, incontinent and a bit senile but clearly well-cared for. The nurse noted quietly to me, "Look how much those two ladies love their mother." Seemed to be true: their mom was confused, stubborn, and clearly feeling the pangs of a hard-lived life (her permanent hunch made her about 3'5" tall), but the good-natured daughters kept her clean and rather sharply dressed. At the other end of the spectrum was a 10 year-old girl with painful urination; it was unclear to all involved why she'd been sent to the fistula surgeon. Off to urine analysis she went.

Then, in between these two extremes, we saw two women of childbearing age whose main problems had actually been inflicted by the Tanzanian medical system. One woman, complaining of incontinence, had obviously had some massive surgery in the past. She wasn't sure what the doctors had done, but the scar on her abdomen was enormous and Dr. Robert pointed out the marks of at least three drains on her belly. "In these cases, we have a song," said Dr. Robert. "You know 'Return to Sender'?" So back she was sent to her original Kilimanjaro hospital. The second woman was suffering uncontrolled urination after her delivery in a Dar es Salaam hospital three weeks ago. The C-section scar was clearly fresh - so fresh, in fact, that the nurse discovered a bit of suture still in the skin that the doctors had simply forgotten to remove. That's hygenic, I'm sure. Oy. Dr. Robert suspected that her problem might actually be due to the C-section itself: every so often doctors will detach the ureters during a C-section surgery and reattach them in the wrong place, leaving them to drip urine into the abdominal cavity and causing incontinence. The problem is technically considered a type of fistula and can be repaired at CCBRT, at least, but she'll need more tests.

And finally, the dye tests. Dye tests are the moment of truth for fistula patients: after two weeks of post-operation rest, their bladders are filled with bright blue dye to see if there's anything leaking out. Two ward patients were up yesterday. One was a success: no blue leaking, even with pressure, so when she fully heals she'll be on her way home. The second, sadly, was a no go - bright blue dye came seeping through her stitches almost immediately. She'll have another two weeks of waiting around with a catheter in hopes that things will spontaneously heal. It seemed very unfair, particularly for this woman: she's 30 years old, but it's clearly been a hard 30 years. She looks to be in her early 50s. And she's all alone - the one child died during childbirth, and her husband left. She deserves some good luck at CCBRT at least. Fingers crossed.