First day at Selian!!

Today was our first day at Selian Lutheran Hospital!! We woke up around 6am to allow time for boiling breakfast water, packing hospital bags, walking down to the main road, and crossing that road to catch the Selian staff bus at 7:20. The crossing part can take up to five minutes because traffic is absolutely crazy here!! We usually latch on to some locals and when they go across, we go.

A candid shot of the road in front of our house (not the crazy main road)

Another Il boru road shot

While waiting for the bus, Kent and Jose drove past in the “green monster” (Toyota Land Cruiser) and stopped to pick us up. They were distraught because someone stole the entire right side mirror off the green monster in the hospital parking lot the day before. They drove us to ALMC for morning report and sala (chapel) and then we headed with Jose to Selian.

Selian is about 20 minutes outside of Arusha down some very bumpy dirt roads. The complex itself is large and fairly peaceful. It consists of multiple buildings including inpatient medicine and peds, surgery suites, lab, radiology, ICU, OB/GYN, outpatient clinic, administration, a chapel, and a cafeteria. In between buildings there’s green grass and landscaped walkways where family members of patients gather and wait. After a short tour we went to the cafeteria for chai and chapati (flat bread) before joining radiology rounds where the interns go over chest x-rays from the preceding week.

Then it was time to begin rounds. I was supposed to start on OB/GYN, but there was nobody in labor, so I joined Katie on the internal medicine team and went to see adult males and females with Jose, 2 Tanzanian interns, and a Tanzania medical student. We had over 25 patients to round on and it took about 4 hours! The wards were cleaner than I expected, but very crowded. We saw many patients with pneumonia, malaria, tuberculosis, and HIV/AIDS (one patient had a CD4 count of 7!!). We also saw a man with a large pancreatic mass, a women with esophageal cancer causing tracheal obstruction, a patient with spinal TB or cauda equina, a women with severe meningitis, a patient with suspected viral encephalopathy, a women with a hip fracture, and a man who overdosed on organophosphates (fertilizer). We used paper charts that were very disorganized and many lab tests that were ordered the day before were not yet back. We were really only able to order basic lab tests and chest x-rays and offer treatment with IV fluids, antibiotics, antifungal/parasites, antimalarials, steroids, basic cardiac drugs, omeprazole, and Tylenol. We could consult surgery and hospice and could arrange for patients requiring more care to be seen in Nairobi (if they could afford and survive the long trip). It was a tiring 4 hours, but despite the frustration I felt that many patients got good care.

We caught the bus home, went for a short run, made dinner, and now it’s off to bed, so we can do it all over again tomorrow!

The Inpatient Medicine and Peds ward

The cafeteria

Selian complex

A shot before church on Sunday

A relaxing weekend!

Tomorrow will be our first day working at Selian, so we decided we needed a weekend of fun and relaxation!

On Friday, Dr. Jacobson's wife Linda picked us up and took us to Shoprite, the "western" grocery store in town. She is very sweet and will definitely be our Tanzanian mother! The grocery store was pretty large and a little expensive, but had lots of good food. I was able to find apples, oatmeal, eggs, carrots, cows milk, raisins, tuna, and of course some tasty cookies (capable of winning a cookie challenge)! When we get a little braver and better with our Swahili we can go to the local market and buy fruits and vegetables for 1/3 the price! Linda also offered to help us buy milk from the cow on our street. We would have to boil it and skim it ourselves, but it would be much cheaper!

In the late afternoon, Eric (a 40 year-old expat that's lived in Tanzania for almost 15 years) picked us up and took us to TGT. This is a large compound on a coffee plantation that has a restaurant, bar, pool, workout room, rugby pitches, and a hotel. It is very expensive and popular with foreigners, so there were lots of white people around. For 12000 shillings (about $10) we were able to use the workout room and swim, while the guys played soccer (no ladies allowed this week, maybe soon). After our workout we did a South African wine tasting. It was great!!

Saturday morning we went for our first run outside!! It is very difficult to run here because the roads are incredibly dusty and crowded and everyone stares at you. Women should have knees and shoulders covered (which is hot!) and for safety it's best to have a male escort (thanks Brandon!). Linda told us about this soccer pitch at the top of our road, so we walked up there and were able to do laps with no dust or crowds. We could see Mt. Meru in the distance and it was wonderful. On the way home the children yelled "Why are you running? What are you afraid of? We will help you!" It was pretty cute! The altitude (~5000ft) is still getting to us a bit, but it will just make running more fun!

Saturday afternoon we had a visit from Grace Msafiri who runs the Msafiri Primary School about 2 hours outside of Arusha by car. She came with her driver, her adopted son Masha, and a young German volunteer to pick up the large duffel bag of sheets that I brought over from the states for the school. She was incredibly warm and gracious. It is custom to invite people in for chai and biscuits, so she stayed for about an hour. She told us about her school and invited us to come visit or volunteer at anytime. We will definitely have to take her up on that!!

Saturday night we went to the other Selian house and made lasagna with Chrisanne (med-peds resident), Jose (MD from Argentina), Jenny (OT from Australia) and Kent (nurse from SD). It was lovely!

Sunday morning we went to church with the other Selian staff. The church is run by expats and they rotate who leads, gives sermons, and plays music weekly. The service was in English, but we were still in the minority. At the end of the service the newcomers go around and introduce themselves and the lady sitting behind me was an Ole!!! What are the chances!?! Um Ya Ya! After the service there was tea and coffee and then an auction to raise money in honor of harvest festival. People auctioned off clothing, produce, cakes/pies/jams, and even rabbits!! After the auction we ate a lunch of pilau (rice with beef or vegetables), pili-pili (pepper chutney), cucumber salad, and watermelon. It was delicious!

We walked home, relaxed for awhile, and then Katie and I walked up the road to the Il boru safari lodge. We said we were Selian volunteers and they let us swim in their pool for free! It felt so good to cool off. Now it's time for a delicious chicken dinner made by Christine and Brandon. Then we are off to bed early to prepare for our first day of work tomorrow!

Safari pictures!!

Tarangire National Park, Tanzania

Elephants and wildebeests. Tarangire has the most elephants per square kilometer of anyplace in the world!




Katie, Christine, and I at our lunch spot lookout

Our driver Frank with Christine and Brandon

A huge elephant skull

Twigas!! (aka girafe in swahili, aka Phil's new nickname!)

Tembos!!

Some impalas near a cool tree

Zebras and Wildebeests. Notice the 2 huge baobab treets in the background. They can live thousands of years!!

Four lions under a tree. They were pretty far away, but still cool to see!

Safari beers at the Safari Lodge!

Tarangire National Park

Today we went on our first safari!! It was wonderful! We hired a driver to take us to Tarangire National Park, which is about 2 hours west of Arusha. The landscape was unique and beautiful. We saw zebras, wildebeest, giraffe, warthogs, impalas, dikdiks, ostriches, monkeys, water buck, and tons of elephants!! Tarangire has the most elephants per square kilometer of anyplace in the world! We did see 4 lions lounging under a tree, but they were about 150 yards away. Pictures to come....

After safari we went for some beers at the safari lodge and then headed back home. We cooked some dinner and ate together by candlelight. Tonight it’s cards and relaxation!

Orientation and Plaster House

Tanzania is an incredibly interesting and totally exhausting country! Katie, Christine, and I began our day with an orientation at the newly built, immaculate Arusha Lutheran Medical Center (ALMC). This hospital is located right in Arusha and is run by the same doctor that founded Selian Lutheran Hospital outside of Arusha. ALMC is a gorgeous building complete with gardens, fountains, and a stained-glass filled chapel. It doesn’t really fit with any other buildings we have seen in town! At the hospital, we attended morning report where the overnight on-call resident presents the newly admitted patients to the rest of the medical team. Next we went to a nice daily chapel service. The singing was incredible! No piano, no guitar, just the local doctors singing Swahili hymns a capella.

After chapel we went with an occupational therapist from Australia to a place called “Plaster House.” We had to ride in a daladala (little minivan) and then walk about 30 minutes up a road with “explosive dust.” The Plaster House is a compound where children go to be evaluated for various orthopedic surgeries and then undergo rehab after their surgeries. They are treated for club feet, fluoronosis (bow legs), burn contractures, and many other ailments. The children are amazing little survivors. They are left by their parents, unless mothers are breastfeeding, and undergo surgery alone. Many of them have casts on both legs and get around by dragging themselves or using crutches. Their bedrooms are crowded and 4 children often have to sleep in 1 bed. They suffer from fungal skin infections, pressure ulcers, and malnutrition (although they are fed well at the compound). Despite all this, they are energetic and loving children! We spent the afternoon playing, doing crafts, and treating some of the milder medical conditions. We left tired, but inspired and talked about the children while we walked the dusty road back to our house.

With the kids at Plaster House

What a cutie!

Making pom-poms

After the walk home we took much needed showers and relaxed for awhile. For dinner we joined the other Selian medical staff for at a delicious Chinese restaurant in town! We had great wine, conversation, and even ice cream for dessert! I wish I could have brought some to the Plaster House kids...maybe sometime soon.

A few house pics

Christine and Katie outside of our front gate

Our house!

Relaxing in the living room!

The kitchen

My cozy bedroom

We made it to Arusha!!

Katie (fellow medical student) and I arrived at the Kilimanjaro airport around 8pm last night. There were very few lights and it seemed as if we were landing in the middle of nowhere. The airport was clean and hot. All of our luggage arrived safely and the only questions at customs were regarding the sheets we brought to donate to a local school and my large bag of tampons! How embarrassing!! From the airport we took a shuttle into Arusha. The road was paved, but dark and the ride took about 45 minutes. Once in Arusha, we turned onto a narrow, dirt road lined with small stores and shacks. After some searching and help from Christine (fellow medical student) and Brandon (her boyfriend), we finally found our house!!

Our house is small, but cozy. We have 3 bedrooms, 2 bathrooms, a living room, dining room, and kitchen. We have a tall gate and a guard that sits outside from 7pm to 7am. It is custom to bring him chai tea at night and hopefully that keeps him awake and alert. After some snacks and catching up, I put in my earplugs, snuggled under my mosquito net, and easily fell asleep.

Today we decided to explore town, which was an interesting experience. I can't even describe the condition of the streets and buildings here. It is very crowded, dusty, and run-down. The people are friendly and I'm already picking up a few Swahili words! The children are adorable!! They run up to us and say "how are you?" over and over again because that's all they know how to say! We bought cell phones and a few groceries and had a lovely lunch at an outdoor cafe.

Tonight we met up with some of the residents we will be working withat their house down the road . We also scheduled a day safari for this Thursday! Yay elephants! We had a great dinner at a local safari lodge and are now getting ready for a first hospital meeting tomorrow morning.

For more information on Selian Lutheran Hospital check out their website...
http://selianlh.habari.co.tz/

Thank you for visiting my blog!! The adventure begins September 20th, so stay tuned...