"But this is Tanzania, my dear"

Only in Tanzania will I see the head of the labor ward cleaning department jump in and take charge of a delivery AND sew up the vaginal tear afterwards.  It was quite weird to say the least.  There Mallory, one of the medical students, was standing over mom ready to catch baby when the janitor just comes up, shoves Mallory out of the way and does the job herself, so matter-of-factly.  Quite strange indeed.  I thought I had seen it all, but that takes the cake for now.  When we questioned a nurse about what we had seen, she shrugged her shoulders and responded in her Tanzanian/English accent, " But this is Tanzania, my dear!"

On a more somber note, I spent a couple hours in the neonate/premie unit the other day.  I could only bare an hour or 2 b/c since they don't have individual incubators, they turn the entire room into a sana of 90+ degrees.  Makes rounding and evaluation quite uncomfortable!  It's sad, b/c there isn't much to be done for these children.  There are no resources here that can simulate the NICUs we have back home.  I am doubtful that I will go back there b/c I don't see the point.  They can give antibiotics to suspected septicemia (triple drug regimen that I can't remember presently), and they do have a half-way working bili light if there is fear of kernicterus/hyperbilirubinemia.  I saw a lot of cerebral palsy, which not much could be done for, and there was an unforgettable case of spina bifida with a big gaping hole over the back about 5-6cm diameter, a myelomeningocele; not certain if this child will get surgery to repair the deformity or not.  I'm sure there will be long term neurological sequelae, even if it does get repaired.

Also, I spoke with some of the nurses in the post-natal ward today, and I asked them what kind of care the neonates get before they are discharged.  It sounds that if there are no problems, they get their oral polio and BCG vaccines, then will be seen again in 6 weeks by the clinic who will give them more vaccines per the Tanzanian vaccination schedule.  If there are no obvious concerns, the child will only be seen when vaccines are required, and the only vaccines that they give here (from the best I can follow) are measles, neonatal tetanus, diptheria/pertussis/hep B, polio, & BCG (for TB).  This is better than most African nations, but this level of care is hardly the standard in the rest of the world.