Update

We've been busy lately and the internet access has been sufficiently unreliable as to discourage an attempt at a long posting. We've accomplished a lot over the last month, especially with emergency obstetrics and neonatal resuscitation teaching. Drs. Mary Hartman and Peter Michelson as well as Janet Fields, nurse midwife, joined us from Nov 3-12 to teach neonatal resuscitation and emergency obstetrics to all of the obstetric providers at KCMC hospital. We have seen the direct impact of this teaching on the lives of women and babies here. One example: We were called a few days ago by one of the residents to an emergency: a woman with antepartum hemorrhage. She had a placenta previa (the placenta is covering the opening of the womb) and had bled profusely at home. We arrived on the scene and the nurses and resident had placed two large bore IV's with fluids running wide open, the patient was in trendelenburg position (head lower than feet, to optimize blood pressure), the operating theatre and blood were being prepared, vitals were being monitored and there was a distinct sense of personal and professional satisfaction amongst her providers that she was receiving the best care possible. Her baby did not make it, but she did. The loss of fetal and neonatal life here is tragically common.

Brandi has prepared emergency kits for the labor ward to deal with postpartum hemorrhage and eclamptic seizures and these are present and available in the ward and have been well received by all of the staff. We have set up refresher courses for all of the providers and plan to assess the level of knowledge and skills retained in this methodology.

We are travelling to Morogoro this weekend for a week long fistula treatment and training camp at Berega hospital and have a similar trip planned to Dodoma in January. We are collaborating with AMREF (http://www.amref.org/) and CCBRT (http://www.ccbrt.or.tz/) with these efforts as well as expanding fistula services at KCMC.

With the help of Vera Mushi, we have identified and travelled to 4 outlying centers to help establish global health rotations for the PA students from Duke. KCMC is a wonderful place to learn medicine, but has many learners and cannot accomodate too many more.

Brandi and Dr. Oneko are meeting with Merck Pharm this evening to discuss potential studies in Cervical Cancer and HPV here in the future. A promising lead.

Looking forward to hearing from you here in Moshi!

JW