First of all, I would like to inform you that the name of our clinic has been changed to BRIGITA General Clinic in September 2024. This was an upgrading in the Tanzanian health system. At dispensary level, we were officially not allowed to do many of our examinations, and to use many medicines that we need for the treatment of our patients. We are still an outpatient clinic, even a kind of referral clinic with a higher level of diagnostics and therapy. It took two years to get this approval! Now we mainly work with doctors who have a university degree; in the past, we only had “clinical officers” with an education of three years at a Clinical Officers Training Centre. There are many medical universities in Tanzania now and it is easier to get Tanzanian doctors for Lindi. Many are unemployed after graduation, because it takes one to two years to get employment. Unfortunately, two of our doctors leave the Brigita Clinic this month. They applied to the government and got a job. Fortunately, we have already found two new doctors who have just finished their practical year and would like to work in Lindi. They have already helped a few days; next week they will take their final exam. It will take some time before they have experience, know the standard therapies and can carry out ultrasound examinations independently. The doctors who will work elsewhere will be able to apply the knowledge they have acquired at our clinic in their new working place. Our daughter Agnes and her husband Abram are not in Lindi any more since the beginning of this year. They went to Germany to do their specialisation. Of course, we are missing them and we have to plan the future of the clinic afresh. We hope that we can find other good Tanzanian employees who can take their place. Especially for the ultrasound department, we would need someone who is competent, and who can acquire a certificate and become a member of the radiological society. I am often asked whether there any progress in Tanzania or whether it is still a poor country. Well, in the United Nations assessment, Tanzania is now considered a lower middle-income country. This is particularly noticeable in residential constructions as many people including employees with lower income and families in the villages have built small or detached houses with tiled floor. In the south of Tanzania, the sale of cash crops like cashew nuts and sesame plays a major role in the economy and contributes mainly to the income of the families. This year, the cash crops could be sold at a good price for export, so that many people have more money at the moment and improve their homes. We also notice it very much in the clinic as the waiting rooms are full every day. Sometimes I even had to postpone 10 to 20 ultrasound examinations to the next day. But not everyone benefits from the boom, still every day some patients are there who need support from the donation fund, because otherwise they would not be able to get all the medication and examinations. Concerning major purchases, this year we bought a faster PC (computer) as new server for the computer system, the old one continuously caused problems. The pharmacy has also received a laptop (a portable computer). The old desktop always switched off after a short time in the event of a power cut, so that the issue of medicines was disturbed very much. Now I would like to tell you about some patients, on behalf of the many who have come to us this year: Mahmud is a 13-year-old boy from Chipite, a village between Lindi and Masasi, with a severe valvular heart defect. Last year he had passed his examination of standard 4, but this year he could hardly participate in class because he was constantly ill. He has been doing better since he has received the heart medications. But if he comes too late for treatment like this time, he has ascites and pleural effusion again (liquid in the abdomen and and below the lungs). I gave him a referral for the paediatric cardiological department of the University Hospital in Dar es Salaam; he may need a heart operation. Some heart operations can be performed in Tanzania nowadays. But the parents have not been able yet to bring him there. I hope he will improve well with the medicines until the beginning of the new school year in January so that he can participate in lessons again. Ahmadi comes from a village in Mtwara. His mother had tuberculosis last year. At the first examination early this year he was not doing well, with fever and shortness of breath at night. The examinations showed a large amount of pericardial effusion. As the effusion was most likely caused by tuberculosis bacteria, he got tuberculosis therapy for six months. Then he felt better, but the effusion was still there. We sent him to Dar, where a large amount of the fluid could be removed, but even when he attended the clinic in October, there was still some effusion the pericardium. I hope that it will now subside with the medication, otherwise he may have to be operated in Dar es Salaam. Last year I told about Rama, an approximately 18-year-old boy from Songosongo with Type 1 Diabetes. He had suddenly developed an almost complete paralysis of the legs. We suspected a Guillain Barre Syndrome, which is a serious disease of the nerves that emanate from the spinal cord (nerve roots). Since there was little improvement at first, we supplied a wheelchair for him. But soon he was able to walk a little bit again, after a few months the family brought back the wheelchair. Rama is now doing an apprenticeship as a bricklayer (!) and is so busy with his work that he orders his Insulin and syringes to be sent by bus. With the sonography, we can often determine exactly what problem a patient has and start with a special treatment. For example, when we examined Selemani, a young patient from Liwale with severe abdominal pain and swelling in the area of the liver. The ultrasound showed a large space of fluid in the upper abdomen, surrounded by a thick capsule, connected to the liver, highly suspicious of an abscess of the liver. The laboratory results also were consistent with this diagnosis. Normally, the condition improves quickly when the patient receives the appropriate antibiotics, even if it takes a while until the abscess has disappeared. This week the patient came back, and the father reported that the swelling had ruptured and discharged a lot of pus. There was still a small abscess in ultrasound, but fortunately beside the liver, not inside. This time I sent him to the referral hospital in Ndanda for surgery, it is too risky on an outpatient basis. Ralia is a 13-year-old girl from Ngapa, a village about 10 km from Lindi. She and her sister are both diabetic, they have Diabetes Type I. When she was still doing well, she came by bus every one or two months together with her sister to pick up her medicine and have the sugar checked. She reported that the sugar was often very low during the night. Sometimes the mother had to take her to the nearby dispensary, where she got a glucose infusion. The sugar seemed to sway very much, sometimes she also sneaked something sweet at school. She was usually fine, and she could go to school normally. But in September she lost consciousness, and her mother took her to the mission hospital at Nyangao. The sugar was normal after a few days, but still she did not wake up. Finally, she was taken to Ndanda Mission Hospital, where computer tomography can be done. The doctors suspected a stroke or cerebral oedema. But at this point, computer tomography and laboratory values were normal. Nevertheless, she still had to be treated in the intensive care unit, she could not speak, sit or eat. Slowly it got a little better, she could swallow again and looked at people. But she still needs to be fed, can neither speak nor stand. The relatives take care of her at home now. Probably a temporary oedema of the brain has caused permanent damage to the nerves. This weekend, the mother called because Ralia's sugar was very high. I told her on the phone how much Insulin she should inject and which food she should give. But I have not seen the child since August, I just know what happened due to her mother’s phone calls and the information that I got from the doctor in Ndanda. We don't yet know how her condition will continue and whether she can ever recover. It is very difficult to perform an optimal treatment in the remote village where there are no diabetologists or experienced doctors. Last week Rajabu, a four-year-old boy, came with his aunt to pick up the tuberculosis medication. His mother has pulmonary tuberculosis, and with our highly sensitive GeneXpert device, tuberculosis bacteria could be found in the boy’s stool. Two months of treatment have already been completed and the child is playful and happy. Soon he will be healthy again – still another four months of treatment. Continuous harm could be prevented, for him and also for his mother. Achmed is a young man from Mnazimmoja. He reported that his abdomen has been swollen for a week, and he was feeling severe in pain. The examinations showed advanced cirrhosis of the liver with ascites (abdominal fluid) and hepatitis B (liver inflammation). The ascites tapping showed that the fluid in the abdomen contained blood, it was red like blood. This may be a sign of tuberculosis, but the medicines for tuberculosis are sometimes harmful to liver. That is why we started the treatment for hepatitis B and gave drugs that increase water excretion to reduce the ascites. But he should rather begin the treatment for tuberculosis under inpatient supervision in the hospital in Ndanda. Halima is a 31-year-old woman from Kilanjelanje, a village between Kilwa and Lindi. She has a small child of about one year. She has had back pain for about a year, she has not been able to walk since May and recently she even cannot move her legs. When she was placed on the examination couch, she was wailing due to severe pain. During the examination, I noticed protruding vertebrae in the lumbar area. The bladder was dilated, even the kidneys were congested, and she had urinary incontinence. Therefore, we first put a urine catheter, and after the specimen for the laboratory tests had been taken, we sent her to the regional hospital for an X-ray of the spine. The X-ray image showed an almost complete destruction of the 4th lumbar vertebra and a displacement of the vertebral bones above. In Tanzania, such changes are mostly caused by tuberculosis. Halima started therapy the same day, and I gave her a referral to the university hospital in Dar. Perhaps an operative stabilisation of the spine can be done there. The damage of the nerves may be irreversible, so she will probably remain paraplegic. But at least the further destruction of the spine can be stopped by the tuberculosis medication. As you see, there are many pleasant and sad stories to tell. With our work we can help many people, with your support also those who have little money at their disposal. We thank you for having compassion for the people here in Tanzania, 8000 km away, despite the problems and troubles at home. In order to support health care and education in Lindi region, we founded the association “Freundeskreis Lindi” (Linid circle of friends) in 2023, through which we can now receive donations for Lindi. It is a registered association, which is recognised as charitable. This year, donations are no longer being settled over the Bishopric of Münster, but will go directly to the association “Freundeskreis Lindi”. Account number: IBAN DE 94 7705 0000 0303 7176 98 BIC BYLADEM1SKB Sparkasse Bamberg If you want to donate, you can note if you want to donate for Brigita Dispensary or Brigita General Clinic or for Eye projects for surgery of patients with cataracts or for other projects (training, education). We have prepared a website on the internet so that you can better imagine the lives of the people here and the work in the clinic. There you can learn more: about Lindi and its people, our association “Freundeskreis Lindi”, the history of the clinic, our work here in Lindi and also Dr. Peter Buchmann’s projects. Dr. Buchmann used to work in Lindi and supports patients with cataract (Eye Camp). On the website there are many pictures that shall illustrate Lindi and our projects for you. If you want to become a member of the “Lindi Circle of Friends”, you can write to me through Whatsapp or E-mail, then we will admit you to the association in the next online meeting. Now we would like to thank you all very much for your support. We greet you cordially and wish you all the best for Christmas and the New Year 2025. Drs. Hildegard and Rainer Vogt BRIGITA General Clinic, Lindi, Tanzania Mobile with WhatsApp: +255 656 578 526 E-mail: brigita-dispensary-yahoo.de Donation account: Sparkasse Bamberg Recipient: Freundeskreis Lindi IBAN: DE 94 7705 0000 0303 7176 98 BIC: BYLADEM1SKB Usage: Brigita General Clinic or Eye project or Education or generally Projects of Lindi Circle of Friends