Day One

Kilimanjaro was in full view as I walked to the hospital at 7:30. I again had woken up at 2 and not been able to go back to bed. Jet lag has become very annoying. From 7:30 to 9:30 I sat in on the general surgery morning report. The intern presented all the admissions from the previous 24 hours and got grilled by all above him on the food chain. A lot like trauma rounds at the MGH. Also unfortunately similar were the large number of head injuries from motor vehicle crashes as well as a smattering of bowl obstruction and one diabetic food. The conference dragged on for 2 hours, which prompted a 45-minute drawn out discussion on why the conference was so drawn out.

The rest of the day was spent meeting with department heads and obtaining approval for the project. The reception was for the most part positive and I was impressed by their insistence that the study be approved by the local oversight board (we had already started that process). One amusing bit was that the major cause of amputation was a source of disagreement between the ortho head and the general surgery head. The ortho head was CERTAIN that trauma was the main cause of lower extremity amputation while the general surgery head was POSITIVE that it was due to peripheral vascular disease and diabetes.

Waiting and then meeting took up the bulk of my day and I came home and showered before going to dinner with Dr Kibiki and his 10 year old daughter Mia. Dr Kibiki has risen the ranks of KCMC over the past 10 years. He went to med school in Bulgaria, then returned to KCMC, did his residency and then a PhD. I got to now him when he was a visiting scholar at UVa and came to my house for Thanksgiving dinner 2005. He is now the director of the research institute and a very busy man. We had a nice dinner at the Indo-Italiano restaurant which specializes in the unique pairing of Indian and Italian food (fortunately not on the same plate). Kibiki was very bullish about Tanzania, its growth over the past 10 years and its prospects for the future. I have little reason to doubt him and hope his prediction to be true. He cited shopping malls and movie theatres as evidence of positive growth, but I wonder if that parallels gains made by the Tanzanians living on less than a dollar a day.