As many of you know, last summer I did my medical clerkship in Olsztyn. It was an experience filled with
russian toilets,
electrocution and random crazy patients. This time around, I am in the jungles of Mozambique, a rather stark contrast to the Polish wilderness. Just last week I was in the small town of Topuito, which, although remote, is the location of
the world's largest titanium ore mine. Using the mine as a base, we would drive out into the surrounding villages each day to provide medical care to people who sorely need it. Thought I'd share some of my experience. Right, let's start from the beginning.
The first part of the journey was flying from Pemba to Nampula, a 40 min journey which easily trumps the alternative 6hr drive there. A small Cessna plane, courtesy of the MAF, then took the medical team from Nampula to Topuito. The medical team being me the medical student, the Dutch doctor I was shadowing, a Dutch nurse and a Portuguese dentist. That was my very first time in such a small plane, and after the 45 min in the air I was both amazed and slightly nauseous. It really is the real deal as far as aviation is concerned, but the ride can be rather bumpy from time to time.
The little Cessna plane.
The Doc and I getting ready for take-off.
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| View from the plane. |
Getting out into the surrounding villages was different from day to day. Sometimes it was a drive of various lengths in the Land Rover, other times it would involve crossing a river in a boat powered by a man with a bamboo stick. Upon arrival, we would each set up our stations and see the patients one by one. People came with various problems, ranging from complaints of headaches to faces filled with massive boils.
During the days I learned the details of proper history taking, i.e. how to ask a patient what their problem is. I also learned a bit of auscultation, and how to do chest and abdominal exams. To me it really feels like the core of primary medicine, being able to hear and feel what is wrong with a patient. It is a skill I think I will need to practice quite a bit over the years. One thing that I would do on a regular basis was to give HIV tests to patients we suspected had the virus. The region we worked in has been hard hit by the virus, and more than once we had to give the bad news to patients. Some would break down and cry, but the majority would just shrug it off as just bad news. One wonders if they have a superior way to cope with their struggles, or don't fully understand the implications of the disease.
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| At the clinic in Topuito |
The clinic in Topuito, just a short drive from the mining complex where we stayed, is a newly built medical center. It has a maternity ward and a wing for the general consults. In maternity we did quite a few ultrasound checks on ladies with complaints of abdominal pain, as well as some pregnancy check ups. The morning consults were usually dominated by kids with fungal infections, HIV patients, and patients suffering from hypertension.
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| Strained selfie at Topuito clinic. |
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| Clinic in Briganha |
The clinic in Briganha was about an hours drive away from the mine, so pretty much smack in the middle of nowhere. Here the nurse turned ambulance driver as a critically ill lady had to be rushed to the nearest proper hospital, which was about another hour and away on a poor excuse for a road. Good thing we had Land Rover. Here there were quite a few exotic disease, including elephantiasis due to lymphatic filiarisis (caused by the wuchereria bancrofti, for my fellow Parasitology survivors) more intense fungal infections, eyes destroyed by bacterial infections, and many weird skin conditions. Of course you had your usual HIV and hypertension patients here as well.
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| Clinic in Larde |
Larde was a special place. It was quite a big town, giving the circumstances, but we had to use a boat to get there. Once the boat had crossed the river, the medical equipment was carried by a couple bikes and mopeds to the clinic itself. In fact, I believe train and hot air balloon were the sole modes of transportation not used on this trip, all in all.
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| Crossing the Larde river. |
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Medical Supplies in "safe" hands.
The boats likewise safe.
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Much learned from this first week, and I have really grown to appreciate the need for medical care in the remote reaches of Mozambique. Next week I'm off to Chiure, which is a medium sized town not to far from Pemba, to continue my medical clerkship at the hospital there. Will try to write up something about it next week. Until then.
