Palliative rounds at Ilula

Ilula hospital palliative care rounds leave one astounded at the caring and commitment of the team.  Two nurses, a clinical officer (comparable to a physician's assistant in USA), and a chaplain travel to surrounding villages to visit patient's with terminal or chronic diseases.  They assess current and ongoing medical, psychological, social, and daily living needs.  These patients are cared for by family members- grandparents, grandchildren, children, spouses, siblings, cousins, etc.   Many times the patient is the sole care provider for other family members.  One I vividly remember was a grandmother with cervical cancer caring for her three orphaned grandchildren.  Another was an elderly woman with no means of support caring for her husband who was bedridden due to a serious hip injury 5 years ago.  Their eldest son had died of malaria when he was in college.  The younger two sons were unemployed and reportedly no help to the parents due to excess drinking. There was no food in the home when we visited.  We left our donuts and energy bars brought along for lunch.  

Another 35 yr old woman living with HIV was experiencing a two day illness with fever, headache, neck pain, coughing, and general malaise.  It was recommended that she go to the out patient clinic at the hospital to be tested for malaria but had no money for the registration fee of 2000 Tsh equal to $1.25 USD.  The chaplain gave her the money. 

On another day at a remote village one of the women living with HIV was experiencing some clinical signs and symptoms of an infection and was advised to be checked at the CTC (Clinton Foundation Counseling and Treatment Center for AIDS and HIV) on the Ilula Hospital campus.  Her only means of transportation were  walking (3 hours one way), riding a bicycle (she does not know how to ride a bike), hitch hiking (unreliable as cars rarely make it to this village due to washed out roads, or hiring a motorcycle which would cost 10,000 Tsh ($6.25).  That was a no brainer!  I could easily donate $6.25 for a motorcycle ride for this community volunteer who was recruiting villagers to be tested for HIV.    In the afternoon this admirable team split up so half could continue visiting patients in homes and the others set up a mobile HIV testing clinic.  20 patients ages 8-70 (12 F; 8 M) were counseled and tested for HIV. One was  indeterminate; one was reactive.  Both were referred to CTC; one for re-testing and the other for ARV treatment.  

Back in the hospital van we prayed the driver would be able to keep the vehicle upright as we curved around potholes, boulders, up and down into washed out sections , and over rutted trails.  Luckily there were only six of us in the back so we could have two buns each on the benches for balance.  On the way up to Dunguya we gave 7 young schoolchildren a ride home for lunch and on the way back we gave a woman a ride to a neighboring village.  They think nothing of squeezing 10-12 in the back and 3 in the front on these outreach trips.

Warm greetings from Tanzania.  Dede