Michael Kiernan - Tanzania

Room one, bed three was one of many patients who I grew close to during my time in Africa. He, like many others, was a patient who was on the ward almost as long as I was. He was a boy or rather a man of 30 years. That would be considered quite young here in the U.S., but seemed to be the average of my patients in Tanzania. He was an HIV positive patient with a failing heart secondary to constrictive pericarditis due to tuberculosis. He required a surgical intervention, but because of his HIV status, the surgeons would not operate. We treated him for two months with anti-tuberculosis, antiretroviral, and heart failure medications. While little was said between us, much was spoken between our eyes. I left the hospital many nights thinking he would not make it through the night for my return in the morning. Nevertheless, the human body can be quite resilient, especially in the young, and he continued to surprise me. In fact, despite receiving medical treatment for a surgical disease, he slowly began to recover and regain strength. His belly, once pregnant with twins, after eight weeks was barely showing. It was a good day when we told him that tomorrow we would sign the release for him to return home. Sadly, that last night was a difficult one for Masawe and in the morning he had once again grown quite ill with fever and abdominal pain. He died quickly that morning and it troubled me greatly; as all too often, I watched him die without ever learning the true cause. It was not his heart that failed that morning.

This was a new struggle and challenge for me--the coping ability to deal with patient death. It is not something we face nearly as frequently here at home. My defense mechanism became that of resignation. I quickly became hardened to the realization that patients do indeed die and there was often little I could due to prevent it. Doctors in Tanzania are forced to practice medicine without the luxury of resources that provide firm diagnosis, and are left to treat patients empirically based on their clinical judgment. This too took some getting used too, as I finally learned to trust my instinct after the many years I have spent training. Patients were treated with a barrage of medications and often got better; however, which intervention made the difference remained frustratingly unknown. It is hard for local physicians to learn medicine in an environment in which they are never truly certain which ailment they are treating. In spite of this, I brought home with me the feeling/knowledge that the daily battery of blood work ordered on patients here likely does little to effect patient outcomes. We are habitually wasteful and chase numbers that may not be worth chasing as the body has the wonderful ability to heal itself when allowed to do so.