Yaoli: The River that Flows in All of Us

July 4, 2009

A heartbeat occurs about once every 0.625 seconds. The myogenic signal starts at the sinoatrial node and blood rushes into all four chambers. Tiny electrical signals, dictated by the opening of millions of molecular voltage gates, travel to the atrial-ventricular node via the Bundle of His. The movement of sodium ions is ultimately translated to a powerful flood of calcium. The ventricles contract, pumping blood to the lungs and the artery highways leading to the rest of the body. In the meantime, just as oxygenated “red” blood leaves the heart, deoxygenated “blue” blood returns and fills the upper atrial chambers.

Laden with oxygen saturated hemoglobin molecules, our erythrocytes travel inside muscular vessels which diverge to smaller and smaller streets. The map of a human body is remarkably complex: more highways than any nation, more alleyways than any city. Yet each cell navigates through the maze with ease… just routine. It happens every 0.625 seconds after all.

Finally arriving at its destination, the oxygenated blood wash over the tissues, bathing the cells in much-needed nourishment and hydration. With oxygen, our body can transform glucose, amino acids, and fats into energy… energy to power our legs, maintain our body temperature, even digest our next meal.

Our blood is our lifeline and the staff at Mwika Uuwo dispensary is its most competent plumbers. Blood pressure check, blood smear, hemoglobin count, ELISA for HIV, fast blood sugar level… these are tests the doctors rely on daily to infer their diagnosis. In addition to providing reliable diagnostic information, the circulatory system is utilized to rapidly deliver remedies throughout the body. Patients coming in with acute malaria or typhoid infections may receive antibiotics through an IV. Elderly patients suffering from dehydration or low circulatory electrolytes immediately receive saline drips to stabilize their blood pressures. In fact, almost all patients in the wards can be seen with a scalp vein or cannula affixed to the back of their hand or forearm.

The nurses diligently monitor the fluid level of the drip bags and change them every 6-8 hours. They ensure that the fluid is dripping steadily through the giving set and into the vein… 42 drops every minute, in fact. For the elderly, receiving an IV drip can be a difficult process. Forcing fluid through veins with poor circulation can be excruciatingly painful and result in edema at the infusion site. Many patients are frightened by the severe swelling and complain to the hospital staff. Clots are another obstacle. They can stop the infusion of fluid entirely and therefore require another needle insertion at a new site.

Blood’s dangerousness rivals its merit. Two of the most deadly diseases in Tanzania – malaria and HIV – travel via blood. The first lesson we learned while shadowing Dr. Raymond was not how to care for patients or treat diseases, but how to protect ourselves. “Any bodily fluid… especially blood, is a very dangerous thing. If you get infected, how can you continue to care for others? You must always wear gloves. After using a needle on another, you must be very careful to dispose of it. If you administer HIV tests, you need to observe the patient first. See if he or she is stable, calm, ready. You need to protect yourself at all times.” This couldn’t be truer. At our dispensary, staff is overworked and in short supply. It operates 24/7 on two doctors and only a handful of nurses. Stanley, the laboratory technician, multitasks between performing diagnostics, giving injections, and filing paperwork. Nurse Flora executes the duties of a pharmacist, accountant and secretary. She keeps records of the drug stocks, files the insurance claim forms, and dispenses the medication. They only get one day off a week and cannot afford to be sick. But of course, in a country as poverty-stricken as Tanzania, no one can.