Hospice

For the past week I have been working with the hospice and palliative care team. They are responsible for providing care and counseling to terminally and chronically ill patients at Selian, ALMC, and in several villages around Arusha. I have had the opportunity to go with them on two outreach clinics to Likamba and Shamborai and both were quite the adventure! For outreach clinic we load a Land Cruiser with supplies, food, medicine, at least 10 boisterous nurses, and a pastor and attempt to traverse the muddy, flooded roads that now surround Arusha as a result of the rainy season. Miraculously, we arrive at a small village church and are met by local volunteers and patients. We have a prayer service and then hand out hospice bags with towels and personal hygiene items. We also provide some fresh fruit and meal packets from Feed My Starving Children! That’s right Mom, Dad, and Charlie…those packets that you assemble on Saturday mornings at the warehouse in Minneapolis really do make it all the way to remote villages across the globe!! Thank you! The hospice patients mostly have HIV or terminal cancer, and we examine them and provide medication for acute infections and pain management. Patients can also talk with a social worker and the pastor to receive additional counseling and support. When our work is done we share a meal, goat stew and rice usually, and then we make the journey back to Arusha.

Patients in Shamborai

I think my parents packed this box!

Yesterday we spent some time at the Gracious School and the kids were especially rambunctious because they are in the middle of exams. The school is in need of another small classroom, a bathroom, and a swing set for next year, so we have decided to do some fundraising! We took pictures yesterday and will be putting together a flier, so stay tuned if you are interested in donating….

The current 4 room school. The new room would be added to the left of the building.

The current choo (bathroom). The new choo would have Western plumbing and the kids would be able to actually wash their hands! That is HUGE for disease prevention in Africa!

The current "playground" has no equipment, so a swing set would be perfect!

Life has also been very busy away from the hospital! I decided to join the church choir for the Christmas season and we have a big play and a carols concert coming up. Our play is a one act opera called “Amahl and the Night Visitors.” I have the coveted role of shepherd and the four part music and memorization is surprisingly challenging. We are having shows on December 10 and 11 and are raising money for the Plaster House. The carols concert in not until December 22 and I’m hoping to be down from Kilimanjaro and back from safari in time to sing!

Happy Thanksgiving everyone!! We are going to a party at the Jacobsons' house and will be enjoying turkey that was shipped in from Kenya (no turkey in Tanzania). I don't think I'll get any lefse, but rumor has it there will be pumpkin bars with cream cheese frosting! Yay!

(ps...Phil comes in 18 days!)

Clean My Car!

Yestreday we went to the Gracious School to do check-ups on the kids! We couldn't escape without playing a few games and singing some songs. I got a recording of my favorite song/chant and hopefully the video will work. Make sure your sound is on!! If you can't understand the words, here they are...

Ester, hello sister. I say come here! Look at my motor car, it is very dirty. Clean my car, clean my car. Shake it more and more and more and deesh!

Last night we went out for dinner and then went to see "The Ugly Truth" at the cinema with Sarah, a few of the Flying Medical Service pilots, and some of the Selian interns. The power went out 4 times during the movie, but we still got our chick-flick fix!

We Did It!!!

Success!! We all reached the summit of Mt. Meru yesterday and lived to tell about it! It was an amazing, but challenging experience and my legs are as sore today as they were after running the TC marathon. Mt. Meru is the third tallest mountain in Africa behind Mt. Kilimanjaro and Mt. Kenya. It’s summit is 4566 meters, which makes it taller than Mt. Rainier in Washington!

Our journey began early Wednesday morning when we were picked up at home and driven to Momela Gate in Arusha National Park. Our group consisted of Katie B. and Amy (my Olaf soccer friends) and Katie H. and me. Between the 4 of us we were allowed to bring 2 backpacks weighing up to 15 kgs each for the porters to carry. In these we packed our sleeping bags, warm coats, hats, gloves, and extra clothes for the summit. We also carried our own daypacks filled with water, snacks, and raingear. At Momela Gate we were joined by 7 porters, a cook, and our fearless armed ranger Tino. Our gear and food was organized and weighed and with some light rain to bless our journey we set out for camp 1.

Amy, Me, Katie B., and Katie H. ready for our adventure!!

We walked for about 4.5 hours through gorgeous dense forest and saw giraffes, colobus monkeys, buffalo, duikers, and bushbuck. The trail was slightly uphill, but manageable. We passed under the strangling fig tree arch and had lunch by a waterfall. We reached camp 1, the Miriakamba Huts at 2500 meters, in the afternoon just before it began to downpour. We had tea and snacks and were joined by two other hikers, Lawrence from Holland and Oliver from Belgium. Around 6pm our cook served us a fabulous dinner of soup, rice, stir fried chicken, vegetables, and fresh fruit. We headed for bed a little before 9pm, but I was sick with diarrhea and vomiting through most of the night. By morning I was weak and tired, but feeling better and ready to continue to camp 2.

Colobus Monkey!

Under the Fig tree arch

Tino scares away some Buffalo

It's just like summer camp...only freezing and on a mountain!!

We set out around 8am for Saddle Hut at 3500 meters. The trail was much steeper and we walked up well over 1000 steps! I was pretty drained from my illness, but arrived at camp around noon. We put on some layers to keep the chill out and had lunch with Lawrence and Oliver. We had the option to climb “Little Meru” after lunch, but it began to pour, so we stayed and played cards and drank tea in the dining hall. We had an early dinner of soup, spaghetti, and fruit and went to bed at about 7pm!! It was freezing and a mouse crawled on my head during the night, so when our 12am alarm went off I was ready to get up and climb! That’s right…12am!!

Our porters passed us on the trail despite their heavier loads!

Lunch at Saddle Hut below Little Meru

We dragged ourselves out of bed, had a light breakfast of tea, cookies, and roasted peanuts, and set out for the summit around 1am. With our headlamps for light we zigzagged single-file up the mountain. We scrambled over rocks, slid through volcanic ash, and shimmed the narrow ridge of the crater rim. Around 5am we started our final ascent up the rocky face of the mountain. We summited just before 6am and watched the sunrise over Mr. Kilimanjaro! It was incredible!! We took pictures, ate snickers, signed the summit book, and then began our descent. By 9am we were back at Saddle Hut and had a breakfast feast. The next 7+ hours were spent walking downhill and this, we discovered, was one of the hardest parts of the journey. We returned to Momela Gate by late afternoon, tired and dirty, but elated! We did it!! We conquered Mt. Meru!! Now it’s time to rest, recover, and start preparing for Kilimanjaro!!

A break at Rhino Point about 1 hour into our summit hike

We made it!! Summit!

Sunrise over Kili

A view of the rocky ascent

Looking at the volcanic ash cone from the summit

A picture for the St. Olaf Magazine!! Go Ole soccer!!

Ready for a shower and bed!

Mt. Meru here we come!!!

I had a good rest of the week at ALMC and a fun weekend!! On Friday night we went to a hospital fundraiser at a local arts school. There was traditional Indian dancing, wine, food, and a silent auction. We met a few other young people that are living here, which is always nice!

Saturday morning we did some women's health teaching at the Whisperer's compound and then at night we took Rhoda (an intern from Kenya) out for her birthday. We went for a nice dinner and then to a dance club in town called Masai camp. The music and crowd were great and we partied until about 2am.

On Monday my St. Olaf soccer friends, Katie Bierlein and Amy Odland, arrived in Arusha! It was so fun to see familiar faces from home! Katie is doing Peace Corp in Zambia and Amy has been in Africa for about a month visiting her. We have been having fun catching up and are leaving tomorrow morning to climb Mt. Meru!! It's a 3 day climb to an elevation of about 4,700 meters! Wish us luck!! I will post stories and pictures when we return!

ALMC and Gracious School

Happy Birthday MOM!! Enjoy your day and know that I am thinking of you!

This week I have been doing internal medicine at Arusha Lutheran Medical Center. It is a newer, more expensive hospital than Selian and attracts a wealthier patient population. We see more "Western" diseases like diabetes and hypertension and less infectious diseases. We have a greater capability to do diagnostics and also more medications available for treatment. Despite this, we still had a young patient die from a severe asthma attack yesterday. We did not have the capability to intubate him and did not have access to the medications that would have surely saved his life in the US. It was very difficult.

Today we went to the Gracious School near our house to do public health teaching to about 50 children ages 3-9. We had a wonderful time!! The school was started by 2 Tanzanian women about 3 years ago and provides primary education to poor children from surrounding rural villages. It is a privately funded school and has grown from a single room with dirt floors to a 4 room school with cement floors, a few tables, chairs, and even chalk boards! The kids are full of energy and are excited to be learning. They sang songs for us and then we gave a talk about hand washing, dental care, and nutrition. Afterwards we taught them the Hokey Pokey and a modified "Duck, Duck, Gray Duck" that became "Simba (lion), Simba, Twiga (giraffe)!" Before leaving we asked them what they would like for their school and their list included toothbrushes, pens, chairs, science books, soccer balls, and a bicycle. One cutie said they needed a computer! We are planning to return in 2 weeks to do check-ups on all the kids and then again in December to bring them some supplies and do more teaching!

Ready to learn!

We gave our lecture outside!

Inside a classroom

Playing "Simba, Simba, Twiga!"

Pediatrics, Cinema, and Safari Adventure!!

I can't believe that it is already November! This past week I continued to work on the Pediatrics ward at Selian and really enjoyed it. The Tanzanian intern was excellent and the ward was busy, but not overcrowded. On Tuesday afternoon we had clinic and had over 20 patients to see after completing our usual morning rounds. Many of the patients in clinic were HIV positive children brought in by their parents for their monthly checkups and refill of HIV medications. It was sad to think about what life must be like for many of these families and what a daily struggle living with HIV is.

On Thursday morning no MDs were able to make it to Selian, so the patients got “Dr. Maiken!” Although I am used to working fairly independently it was scary to have no second opinion and no backup! We were cruising through rounds when a nurse came in and said there was a new admission to the ICU that I needed to see right away. Ahhhhh! The patient was an 8 month old baby having significant difficulty breathing because of presumed severe pneumonia and acute bronchiolitis. With the help of a nurse to translate and my Oxford Handbook of Tropical Medicine we began treatment and by Friday morning rounds the baby was much improved!

Friday night the interns invited us to join them for dinner and a movie at the shopping complex in Njiro! The complex is a ways out of town, but is very Western and lovely. We were all craving Mexican and finally found some tasty guacamole and burritos! We saw the movie District 9 and although it was horrible we still had a great evening.

On Saturday we went on a day safari to Arusha National Park with Dr. Jacobson, Linda, and Dr. J’s cousin Shelley. We took the Green Monster (old Toyota Land Cruiser) and it was misbehaving as usual. It had to be pushed several times to get it started, but we didn’t think much of it. We saw zebras, giraffes, buffalo, baboons, and bush buck. We also got to see the alkaline lakes that are home to millions of flamingos! The entire lakeshore and all of the little islands were covered in pink! We stopped for tea at an observation point and when it was time to go the Green Monster decided it had had enough. The engine revved and smoke came billowing out of the hood! Dr. J called for a car to come tow us and while we waited we had a lovely 3 hour lunch! When our rescuers finally arrived we used a metal cable to tie the Green Monster to the other car. Unfortunately, the Green Monster was so heavy that our cable broke 6 times! At one point we had to get out and run beside the car up a hill as baboons and giraffes followed us! It was quite a fun adventure. We left the Green Monster at the park entrance and made our way back to Arusha! Linda’s chocolate cupcakes with chocolate frosting made all of our struggles worthwhile!

On Sunday we went to church and then Katie and I went for coffee at Sarah and Jack’s house down the road. Sarah is an occupational therapist from Australia and Jack, her husband, is a pilot from Poland. In the afternoon we went for a swim at the safari lodge and then went to the flying medical service dinner.

This week I will doing medicine at ALMC (the new hospital in town) for a change of pace!

One of many baboons

Flamingos!!



The Green Monster starts to misbehave and needs a push start

Tea time

The view from the observation point...where we spent many hours!

The Green Monster has had enough...thank you rescuers

All set for a tow out of the park