I spent the first two days in Orthopedic Surgery here at Bugando hospital, but my contact/minder has left for Dar es Salaam, and I was bored by bones pretty quickly, additionaly, everything and everyone here develops infections, so it was revision after revision, of nasty pus dripping bones, and I'll be doing more surgery in Zanzibar.

So, I switched to the ICU, which is run by two young German guys, Dr. Koblher and Dr. Schmidt, both brilliant, tireless and totally committed to raising the standard here. It's been a pleasure to work with them and the two great Tanzanian house officers here, Drs. Linda and Andrew.

The ICU here has about 20 beds, is well stocked with all of you basic antibiotics and anesthesia medications, has four ventilator (of varrying ages), an ultrasound machine, and a well stocked lab run on a German reserch grant looking at the utility of prednisilone in delaying the use of anti-retrovirals in HIV patients (prolonged CD4 count above 400), and a great EKG machine with suction cup electrodes.

Even so, much is lacking, lab results for a patient with a Hgb of 2 and a platelet count of 2000 took close to 6 hours to move from the technician to the houseofficers and although whole blood was available, additional fresh frozen plasma was not. The patient in question was only 17, she had had an illegal abortion and developed bleeding and cardiac arrest, we revived her but she unfortunetly passsed during the night.

Many of the patient's conditions, whether they are in the ICU following a motor vehicle accident, or severe pneumonia of meningitis, are complicated by the ever present spectre of malaria, which claimed the life of a tiny 4 year old this morning. Cerebral malaria, and sudden multisystem collpase with flash pulmonary edema, acute renal failure and and vascular congestion, sometimes called Algid Malaria is less common but still a serious problem here.

Ran into two fellows from Cornell/Sloan Kettering last night and got drinks, watched England crush Slovenia 5-0. We may head to the Ngorongoro crater this weekend, I hear the have lions, tigers and bears, should be sweet.