Pediatrics and Arusha National Park hike

Since returning from the flying medical mission in the bush I have been working on the pediatrics ward at Selian. It is great and the kids are adorable! We begin the mornings rounding on the newborns. Right now we have 2 premature babies that each weigh less than 1.5kg sharing the “incubator.” They are both surprisingly healthy, but are not gaining weight and will probably be in the hospital for a few more weeks.

After doing newborn exams we round on the inpatient ward. Many of the kids have malaria, pneumonia, diarrheal illnesses, and malnutrition. We had an admission last Friday of a 4 year old HIV positive girl who was treated for tuberculosis and now has a bad pneumonia. She was brought in by her grandfather because her father is no longer living and her mother is sick with AIDS. She was so precious and was too sick to even cry when we examined her or drew blood. Her liver is enlarged and she has a cardiac arrhythmia in addition to her pneumonia. She needed an urgent chest x-ray and our machine was broken, so she had to be taken all the way into town just for the x-ray. Today she was improving, but is still very sick.

We had a fun and busy weekend as well. We have discovered that with the rainy season comes frequent power outages, so we spent Friday night drinking wine and playing cards by candle light. On Saturday we went for a long hike in Arusha National Park with the teenage girls from Whispers of the Jungle (the orphanage where we are doing women’s health teaching). We set out from their compound and hiked up dirt roads, through steep terraced mountain farms, into deciduous forest, and then into jungle! It was a tough hike and the girls were great sports! We had quality bonding time and by the end were walking arm in arm singing songs and talking about boys! When we got back to their compound it was dark and I had my first experience with a squat toilet. This is what all the locals use and it involves 2 boards next to a cement hole. You stand on the boards, squat down, and aim as best you can! It was actually easier than I thought! On Sunday we went to church and I was asked at the last minute to do the readings. After church we went out to lunch with Dr. Jacobson, his wife Linda, Kent, and a missionary couple that lives on our road. We relaxed in the afternoon and then went to the flying medical service dinner. We got news that Gerald the goat is still alive and well and despite 4 power outages during dinner we had a great evening!

More flying medical photos

Cute kids outside of the clinic

The elders enjoying our cokes

Poor honey!! She really hated us!

Waiting to be seen...

Working with Barnabus

More baby weighing!

Flying Medical Service!!

Early Monday morning Christine and I had a sudden change of plans when we received a phone call from the flying medical service! The volunteers that they had scheduled to staff clinics for their 3 day mission to the bush didn’t show up and they were hoping we would be able to join them last minute. We quickly packed overnight bags, grabbed our stethoscopes and medical books, and took a cab to the Arusha airport. There we met Ezra, a young pilot from Pennsylvania that has been in Tanzania for 4 years. He was loading up a small, 6-seater Cessna with suitcases of medicine, a metal table, and some camping stools. We boarded the plane and took off for the small village of Emborate about 30 minutes South of Arusha.

A Masaai boma from the airplane. Their huts surround a center circle where they keep their livestock overnight.

Before landing in Emborate we had to buzz the dirt runway to scare off the herd of goats grazing there. The village of Emborate has a population of about 2,000 and their Catholic mission served as our home base. We dropped off our overnight bags and picked up Barnabus, a clinical officer from Tanzania that looked to be about 12 years old (yay Doogie Hauser). We hopped back in the plane and headed to our first clinic.

The flying medical service has almost 30 bush clinics that are visited about every 2-4 weeks. In order for villages to get a clinic they must build and maintain a dirt runway and a mud or stick hut that we can see patients in. If they fail to do this then the medical teams stop coming to their clinic until they fix their “facilities.”

A 2 room mud clinic

A stick clinic with some waiting patients

Looking out of the "window" of the clinic on some waiting patients

Seeing patients

Our main goals at each clinic were to weigh and vaccinate children, do prenatal exams on all the pregnant women, and see all the patients with acute medical problems like coughs, fevers, abdominal pain, rashes, etc. Our first clinic was a two room mud hut in the middle of nowhere! I started with prenatal exams and saw over 20 women. It took almost 4 hours for us to see everyone and then we had a lunch of bread, jam, and warm sodas under the wing of the airplane. We headed to our second clinic and did much of the same work. I helped Barnabus see patients and dispense antibiotics, antimalarials, antiworms, vitamins, and a variety of other medications. After another 3+ tiring hours we finished and left for our final clinic of the day. When we arrived only 4 men were there and they informed us that a herd of elephants had just run through the area and scared all of our patients away! Only in Africa!!

We returned to Emborate and had a nice dinner of rice, beans, cabbage, and fruit with the town priest Joseph who is from Brazil. We were exhausted and went to bed in the simple guesthouse shortly after dinner.

On Tuesday we woke up around 7am, took freezing showers, and had breakfast with Joseph and Ezra. We only had one clinic to do, so there was time to explore the village before boarding the plane around 10:30. Clinic was very similar to the previous day except that when we arrived there was a goat tied up inside the hut! Christine and I had a good laugh and I asked Ezra if my pregnant ladies should just lay by the goat for their exams. Ezra informed me that this goat was a gift for another pilot and would be coming back to Arusha with us! Once again…only in Africa! After a long clinic we had a lunch of bread and sardines. We gave our cokes to some of the tribe elders and they were thrilled! We tied up the goat (aka Gerald) and put him under the plane and returned to Emborate. Gerald was put in the chicken coop for the night, so that he wouldn’t get eaten by hyenas! We helped Joseph make dinner and got to eat delicious, illegal Impala! Impala are like antelopes, but cannot be hunted for food. Tourists, however, hunt them for trophies and then the local guides give the leftover meat to Joseph because he is a trustworthy priest! After dinner we drank beer, played cards, and sang songs before bed.

Gerald the goat inside clinic!!

An adorable family!

Wednesday we had two more clinics and they were both very busy. At the first clinic I did more prenatal visits and at the second clinic I weighed and vaccinated 32 children! To weigh the children we hang a scale from a tree branch or a rafter of the clinic hut. Moms then put their babies in cloth bags and we hang the bags on the scale. The kids slump awkwardly in the bags and inevitably start screaming and the mothers are always hesitant to let go completely. It is quite a hilarious process! After clinics we returned to Emborate to drop off Barnabus and say our goodbyes. We flew back to Arusha and were able to see Mt. Kilimanjaro from the air. It was incredible! Outreach clinic is an exhausting, but rewarding experience and I’m sure we’ll have the chance to go again!

Vaccinations!

Weighing babies from a tree

Pictures from the circus and Arusha Lutheran Medical Center

Christine, me and Katie outside of the circus tent

VIP from row seats!

Some cool African drummers and dancers (no flash aloud, so sorry it's blurry)

Katie on stage with the clown!

The gorgeous new Arush Lutheran Medical Center. We will be spending some working and researching here too!

The gardens inside the hospital!

A woman carrying bananas up our road

A Cultural Weekend!!

Yesterday marked my one month in Tanzania milestone!! The days seem to pass slowly, but the weeks certainly fly by. We ended up staying in Arusha this weekend and partaking in some local culture.

On Friday, we went to the new hospital to meet with Dr. Jacobson and start our research. We encountered a few snags in data gathering and may have to rethink our project a bit. In the afternoon we went for lunch at Bambo Café and then Christine and I headed to the Arusha Natural History museum. It was pretty hilarious! We paid 2000 shillings ($1.50) for entrance and a guide. The museum had human skeletons and dioramas of ape-like people eating berries. They also had exhibits on locusts, mosquitoes, and tsetse flies. Some of the lights were burnt out, so our guide used his cell phone to illuminate the exhibits! We also saw a taxidermy room, a tilapia fish pond, a tortoise, and some historical pictures from the time of German colonization. Let’s just say it was no Smithsonian! After the museum we stopped at Meat King for groceries, walked home, and I went for a short run. At 6:30 Babu Kent picked us up in the Green Monster and took us to Khan’s bbq for dinner. This restaurant is an auto shop by day and in the evening they set up big bbqs on the sidewalk and serve fabulous chicken, beef, and mutton (sheep). We had a feast and then headed home to sleep!

On Saturday morning, Brandon and I went for a run and then we all headed into town to go to the circus!! The circus travels around East Africa, but most of the performers are from Tanzania. We paid about 7000 shillings ($5) for VIP front row seats! The tent was small and intimate and the show was like a mini Cirque du Soleil. They had acrobats, jugglers, contortionists, “strong men,” and of course a clown. I was pulled on stage during the juggling act and Katie was pulled on stage by the clown! It was an entertaining show and I think only African men (and Phil of course) could look that good in that much spandex! After the show we went for dinner at Dragon Pearl and then met Kent, Chrisanne, and Rob at the Impala for drinks and dessert. A fun and busy day!

On Sunday we went to church (which is always a 2+ hour endeavor) and then Kent drove us to the Arumeru Safari Lodge to pick up a box of Kilimanjaro supplies left behind by Christine’s doctor friends! They left us hats, a sleeping pad, water purification tablets, Clif bars, hand and toe warmers, and antibiotics and altitude sickness medication! Yippee! Kent then took us to Le Jacaranda for lunch and we had a lovely afternoon sitting outside and talking. We came home and relaxed for awhile and then we went to the Flying Medical Service dinner at the Arusha Coffee Lodge. This is a group of about 20 pilots, nurses, and doctors that are in charge of flying sick patients to various hospitals in the region to get treatment. We are hoping to go on some missions with them and wanted to do some networking. The lodge was gorgeous and the pilots had great stories to tell!

Today I am starting pediatrics at Selian!!

ps…56 days until Phil comes to Tanzania…in case you were wondering :)

A few Questions Answered

We are all mostly recovered from our illness and life has returned to normal. We were housebound much of this last week and I don’t have many new, exciting stories to tell, so I will answer some of the questions that I‘ve been getting!

What is the weather like?
Winter has just ended here and we are entering the short raining season and summer. It is very dry and we have had only one decent rainstorm in the last 3 weeks. Temperatures during the day are in the low 90s, but it’s a dry heat and there is usually a good breeze. Mornings and evenings are nice and cool (upper 60s) because of the altitude. The short raining season is supposed to last into early December and I guess we can expect daily short rainstorms although those haven't started yet.

What is rounding and what is its purpose?
Rounding is when the physicians, interns, students, and nurses go around the wards and see all of the patients. We usually see one patient at a time and the interns and students “present” the patient to the attending physician and the rest of the team. This means we say what the patient was admitted to the hospital for, what diagnostics and treatments they have had (their hospital “course“), and how they have done since the last rounds. The team then decides what further studies and treatments should be done or if the patient can go home and on what medications. The physicians also use this time to ask questions of the interns, teach, and point out interesting physical exam findings.

How do you do your laundry?
We are very spoiled because we have a maid that comes to the house 3 days a week. It is the norm that “wealthy” people here hire maids, night guards, and day guards/lawn maintenance people in order to provide jobs for others in the community. Who would have thought that 3 indebted medical students could be considered wealthy! I have never actually watched our maid Mabo do the laundry, but I believe she puts everything in a bucket with soap and then either beats it or rubs it on washboard! She gets things surprisingly clean and then hangs them on a line to dry! There is no fabric softener, so our socks stand on end when they come off the line!

Do African ladies really carry things on their heads??
Yes!!! It is incredible what the women can carry on their heads! Large tubs of vegetables, heavy buckets of water, huge piles of wood and sugar cane, or just their little purse! It is also true that very young children carry their siblings on their backs in shawls. Kids also play in the street rolling old bike tires or other wheels with sticks. I’ll have to try to get some pictures!

Are there lots of bugs in your house?
We had a few cockroaches when we first moved in, but it appears we have scared them away! We do have several salamanders and they are cute unless they fall out of the tea box onto your shirt and scare you half to death (yes this happened to me!). There are mosquitoes, but we haven’t gotten too many bites. At night we hear lots of fruit bats that make this high pitched beeping sound. At first we thought it was something electrical in our back yard, but the locals set us straight. We also have bush babies, which are little marsupials that live in the bushes and make noises that sound like babies crying. There are cows, goats, roosters, and dogs all over the place. I have tried to make the flea infested, worm carrying tiny black kitten in our yard my pet, but my roommates say no!

Hope that answers some of your questions and I’ll be back with more stories soon!

A few pictures...

We had a pretty uneventful weekend due to our suspected swine flu outbreak. We are on the mend, but still having Sprite for breakfast, lunch, and dinner. Here a few pictures from the last week!

This is the contraption we use to listen for fetal heart tones. I have still not mastered it. This cute young lady is very pregnant with twins!

The view from the soccer field that we run around. That is Mt. Meru in the distance! Gorgeous!

(ps...planning to climb that Mountain Nov. 11 with some Ole soccer girls! Um Ya Ya!)

Some cuties up by the soccer field. They ran to have their picture taken as soon as they saw me.

The road up to the soccer field. This picture doesn't do justice to the purple Jacaranda tree. They are incredible and in full bloom right now!

I loved this sassy little girl!


Some boys along the road to Selian. Please not the machete/sword that the boy in orange is leaning on...really!?

Along the road to Selian


Some girls on their way to the school. The uniforms here are so cute. There are different colors and styles for every school

Some houses near our house

Swine flu...

Our whole house is at home today sick with H1N1. Of all the illnesses to get in Africa we get swine flu!! It's definitely as bad as they say it is...ugh. Back to bed...

International Criminal Tribunal for Rwanda

We have designated Wednesdays as our “day off” to work on research projects, do community outreach, and run errands (going to the grocery store can take up most of the day here). Today we decided to attend the International Criminal Tribunal for Rwanda (ICTR). This is an international court located in the government building in Arusha that is responsible for judging people involved in the Rwandan genocide of 1994. The Rwandan Genocide was the ethnically motivated mass killing of the Tutsi people by the Hutu people. An estimated 800,000+ Tutsi were murdered in approximately 100 days (“100 day war”). The movie “Hotel Rwanda” is based on this conflict and I would highly recommend it (Phil owns it, so ask him to borrow it).

The ICTR was established by the UN in 1994, so trials have been going on for 15 years! I feel like this is a prime example of African inefficiency (although I’m sure the UN is partly to blame). So far, almost 30 people have been convicted of genocide, crimes against humanity, war rape, and media propaganda. To get into the government building you have to trade your passport for a visitors badge and go through a metal detector. In the ICTR wing there are 4 separate court chambers and trials begin at 9am and 2:30pm. The public sits behind a wall of windows and listens to the proceedings through headphones. The prosecutor asks questions in English, which are translated for the witness or accused and their answers are translated back into English (a long process). The first trial we tried to attend ended up being closed to the public because the identity of the witness was protected and the questions that were going to be asked were sensitive to their identity. The other trial we attended was for a top Hutu general. A man was being questioned about this generals involvement in the massacre of about 200 Tutsi.

After the ICTR we ran some errands and went for lunch at the Masaai Café. This is our favorite pizza place in town. We then made a trip to Meat King for beef, yogurt, and cheese (it’s tough to find safe meat and dairy products, but this place can be trusted). We went for a run to the soccer field when we got home and their was a game going on. The players were awesome! We watched for awhile then headed home for dinner and some relaxation. Hopefully we’ll be able to find a way to watch the Twins game!!

Random pics from the last week!

Chrisanne, me, Megan, Christine, and Katie outside the sala (chapel) at Selian



The adolescent girls that we visited to teach about "female issues"


The girls cooked a dinner of chapati, rice, goat stew, spinach, and chicken. We ate out of wooden bowls and they actually gave us silverware!!

The bracelets that we brought were a big hit!

At Praygod's house for dinner. The camera is staight ahead buddy. Also in the picture, his mom, sister, and 2 cousins.

Katie with Praygod, his sister in law, and her new baby. Adorable!!

Our dinner at Praygod's. Goat stew, potatos, and fried green bananas. Love the tweety bird place mats!

OB/GYN and some fun dinners!!

This week I am rounding with the OB/GYN team at Selian. It’s a nice change to do something totally different! We begin our mornings rounding in the labor and delivery ward. The patients who gave birth the day before or overnight are in bed resting with their babies. They have to wait 24 hours after delivering to be discharged, so we ask them about bleeding and check their uterus size. In this same ward are any other pregnant admits. They have a variety of medical conditions, but we’ve mostly seen malaria, UTIs, pneumonia, and premature labor. We are able to order ultrasounds for dating, but it is questionable how accurate these are. The interns estimate gestation by checking fundal heights and we listen to fetal heart tones with this hilarious stethoscope with a cone that you press into the abdomen with your forehead. I’m going to have to try to get a picture of this because words just don’t do it justice! We then check on any women who are in active labor. Today two women had spontaneous abortions of twins, one was about 23 weeks and the other 25. There is nothing we can do to try to save babies that premature, so it is very sad. The women and doctors here are accustomed to this. For one woman this was her 9th pregnancy and the other it was her 5th.

After finishing with labor and delivery we go to the GYN ward and round on women who are pre or post-surgical or have gynecologic complaints. There they deal with problems like vesico-vaginal fistulas, urinary incontinence, and PID. On Monday we saw a patient in her 60s with advanced stage cervical cancer. The Tanzania doctor asked me how we deal with this in the states and I had to tell him that we rarely see it anymore because of pap smears, HPV testing, and other preventative measures. He was shocked! The patient died overnight.

On Monday night we met three doctors that Christine knows at Arumeru Safari Lodge for dinner. They are in town for a 7 day Kili climb and a safari. One is an ER doc, one an anesthesiologist, and the other an ophthalmologist. We had a great evening and they enjoyed hearing all of our stories from the hospital.

On Tuesday night, Katie and I were invited to Praygod’s, a Tanzanian intern, home for dinner. It was a wonderful cultural experience! We were introduced to his entire family and they were very welcoming. We talked and watched East African TV for about 1.5 hours while dinner was being prepared. The food was brought in along with a pitcher of warm water and a basin to wash our hands in. We dished up fried bananas, potatoes, goat stew, and fresh fruit and then realized that there was no silverware! Tanzanians eat with their hands, but at most restaurants they have silverware for the wazungu (white people). Not here! We ate as politely as possible with our hands and the food was wonderful. We said our thank-yous and goodbyes and Praygod drove us back to our house.

A busy first week at the hospital

We have survived our first full week at the hospital! Everything in Tanzania, except the traffic, moves very pole-pole (slowly) and medicine is no exception. The combination of inefficiency and limited resources leads to many frustrations with some interspersed triumphs. Labs are not run, medicines are not given, consults don‘t happen, x-rays aren‘t taken, and the ultrasound machine is perpetually “broken.” Two doctors from the US had to donate blood to their own patients because the blood bank was empty and I’m sure I’ll be doing the same sometime in the future. There is also a huge language barrier. The nurses and interns have to translate everything from Swahili into English and sometimes from Masaii (a common tribal language) to Swahili to English. It takes forever and lots of the patients history is left out. On top of this, the Tanzanian interns lack the training and knowledge to make correct diagnoses and initiate proper treatment on admission. A majority of patients are diagnosed with pneumonia - rule out malaria and, although this is common here, it is often wrong.

We had very full wards everyday this week and also had several ICU patients to round on. Three of our patients died, which was difficult for us to accept, but a very normal reality for the locals. I experienced my first exorcism! It was performed on a patient in a coma from suspected TB meningitis and was very interesting and a bit scary. It drew quite an audience and lasted for about 5 minutes. There was lots of yelling and hang gestures and the patient ended up having a small seizure afterwards and then died the following day.

We also had busy evenings this week! On Wednesday evening, Mark and Linda Jacobson had the entire “Selian crew” over for a lovely spaghetti dinner. There were 13 people there and the food was delicious. It was a great taste of home in the middle of a long week.

On Thursday evening, Babu (Grandpa) Kent took us to an orphanage for adolescent girls to do some women’s health education. The girls were great! There are 19 of them ranging from about age 7 to 18. They are taken in and given a chance to go to secondary school, which is equivalent to high school, but costs money in Tanzania. Our main objective was to teach them about self-breast exams, but we discovered that they had a million questions about other female issues too. We needed more time to talk with them, so we are going to set up a little curriculum and go back to the orphanage for more teaching. Before we left they served us a wonderful dinner of chapati (delicious wheat tortillas), rice, goat soup, and spinach.

Friday evening we went to ViaVia in town for drinks and dinner! It was relaxing and we were home and in bed by 10pm!