AVC

Impending genocide in the Democratic Republic of Congo. Cholera in Zimbabwe. HIV/AIDS. Collapse of the auto industry in the US. Global economic crisis! Are we having fun yet? If you are a VSO volunteer in Tanzania, the answer is yes! Because we just finished AVC! (Annual Volunteer Conference), a 3 day conference in Dar Es Salaam for all of the volunteers in Tanzania, Zanzibar and on the island of Pemba to discuss our issues. Those issues being - the work that we are doing, the strengths, challenges, the issues surrounding our respective sectors - "HIV/AIDS", "Secure Livelihoods", and "Education". We listened to individual and group presentations on "conflict management", "gender and HIV mainstreaming", received information from DFID (Department for International Development), watched an emotional and inspiring documentary on HIV/AIDS, and played the "Africa Game" during which time I found myself running around a pool with a bucket of water on my head. I came away soaked (but victorious)...
Getting back to the point, AVC was a very positive meeting. For me I came away with a better understanding of where VSO is, what volunteers are doing, and where we would like to be in 2009. The VSO Tanzania country director has said that despite the challenges (including the global credit crunch), that 2009 is promised to be a very good year for VSO - because next year a new CSP (Country Strategic Plan) will be developed. The CSP is important because VSO will hopefully make changes that will bring about better, more succesful placements to improve its development efforts.

I'm traveling back to Lindi tomorrow. 8 hours on the bus (6 hours on paved road and 2 hours on unpaved dirt :). I should be back in Lindi by 2pm, barring any flat tires and that we leave on time!

What's the message? I don't know. But despite the multitude of crises around the world, the seventy-plus VSO volunteers in Tanzania had a good and safe time in Dar at the AVC:) The picture was taken during lunch on day 2. The rest of the pictures will be uploaded onto Facebook.

Happy Holidays, and Happy New Year!

Hamna Umeme

"Hamna Umeme" translates to "There's no electricity". "Hamna Umeme" was the theme of today's clinic this morning. From 9am to Noon we had no electricity and I ended up telling almost all patients that unfortunately "hamna umeme" because when there's no electricity the hospital practically shuts down - the lab can not run any specimens and the radiology department can't use the back up generator, so patients can't get imaging. This means patients end up waiting extra long hours, usually the entire day to get treated. And usually the patients come back and tell me that there is no electricity. I tell them that unfortunately "hamna umeme" you just have to wait.....
The last two days were holidays due to Tanzania's independance day. I'm sure most people enjoyed having the last two days off, however, most people who enjoyed the last two days off ended up coming to the hospital sick today. The number of patients waiting in clinic was huge and at the reception desk, there was a continuous mob of people squeezing their way in to get a chart to see a doctor. I saw about twenty or thirty patients by noon and I ended up telling almost all of them that unfortunately we don't have electricity at the moment, so you just have to wait. Luckily the electricity returned around noon just as I was telling one of the last patients to wait.
All of my patients finished getting their labs drawn by about 3 pm and then the patients I had to scan all turned up at ultrasound.
The last patient I saw today was a young girl with five children. She was admitted to the hospital with a pregnancy of about 26 weeks and severe anemia. We scanned her today because of "size greater than dates" (in other words the size of the uterine fundus was greater than the number of weeks of pregnancy). The scan showed viable twins with concordant growth. I waited until after the scan and documentation to tell the woman she had two babies because I wanted to see the expression on her face when I told her the "good news":). I looked straight into her eyes and told her that she can expect two healthy babies :) I waited and waited, but she had absolutely no change in expression on her face! I asked her if she understood me, and she said she understood. But still no change in expression on her face! I was disappointed and confused that she looked emotionless. I just told her to return to the ward. I don't know how this woman will manage to support and raise seven children!

Future AMOs

Future AMOs (Assistant Medical Officers) of Tanzania. In about 6 months this class of 43 students will graduate and become Assistant Medical Officers. I have been teaching these students every Tuesday and Thursday for the last month on various ob/gyn topics. The majority of students seem to have a fairly good understanding of the material which I have taught so far, based upon the questions that they ask; however, I haven't given the students any examinations...yet, so I have no objective data to support my efforts. When the students are not in class they are rotating in various wards and clinics in the hospital in a curriculum which you might compare to that of 3rd year US medical students.
The picture above was taken at the end of my lecture today on cervical cancer....I'm always happy to see that everyone's eyes are open at the end of a lecture, especially since I lecture in the afternoons right after lunch!

Free Mangos

This was the scene at my house this afternoon. Looks like 8 little children are being held captive behind bars! Instead all of the kids are shouting for mangos at my front gate. Hadija, my housekeeper, is a little more generous than I am. I feel that if the children are given mangos that they will continue to return to my house and pester me for more mangos. Call me the grinch but I don't think its a good idea to be giving away mangos to little kids! Despite my pleading Hadija gave in and she gave the kids a few mangos! Surprisingly with only a few mangos, the kids left my house peacefully without protest or riots:)

No bones for you

Holiday presents arrived early this year for my 3 dogs, Obama, McCain and Bush. They are 3 lucky dogs!! The 3 of them received meat filled bones, chew toys, and a bunch of biscuits and treats courtesy of my parents, Allan and Darlene. Thank you!:)

The dogs were definitely surprised and very excited to receive their treats. As you can see, McCain is busy chewing away at a bone. Bush was also busy biting into her bone as was Obama. As soon as Obama received his bone, he took off running around my backyard in excitement. I went looking for him to take a picture but he's no where to be found. I think he's hiding in the bushes so no one can find him and steal his treat!

Another VVF

I saw four new VVF (Vesicovaginal fistula) patients in clinic today. Some VVF patients come from a dispensary or health facility with a referral letter requesting further management. Other patients simply come with the complaint of leaking urine. Sadly there are thousands of new VVF patients every year. For more information about VVF just 'google' VVF. Photo above is courtesy of bop.nppa.org.

The five patients I operated on on Friday were all doing okay this morning. And there were no seriously sick patients in the gyn ward. In Maternity we had a new case of ecclampsia and a mother who just arrived with severe anemia after delivering her baby at home.

I requested a consult from a medical doctor on one patient with presumed "tropical splenomegaly syndrome"... And I consulted medicine for another patient with a significant amount of ascites. The patient with ascites is a young girl who came with a distended abdomen and nausea vomiting. The etiology of the ascites has to be "worked up". I think we would be able to do a paracentesis although the lab would probably not be able to analyze the fluid.

On a separate note, I "fired" my plumber after two and a half months of aggrivating arguments about leaking faucets and water pumps not working. Fortunately my security guard knows another plumber who he recommends. And there is no real "urgency" to get the plumber here because now that the short rains have begun, I can use the rain water to cook, clean, shower, etc......everything except drink!

Tomorrow is a teaching day at the COTC (Clinical Officer's Training College). Our topic is cervical cancer. Definitely an important subject to teach Lindi's future doctors. There are definitely a lot of patients with cervical cancer and we are fortunate to have enough funding to help these patients get to Dar Es Salaam for treatment or if we catch the disease early enough to treat the patients with surgery.

A Full Moon

We had a full moon the other night. Maybe it was the moon's effect but a few strange things have been happening around here. At work its been unusually busy! Not a bad thing, just more work..... And one of the AMOs in the department is on 'likizo' (Vacation). The other AMO in the department is away at a teaching seminar. Thursday I spent most of the day doing ward rounds in Maternity. Almost a full day of rounding on patients because there are a ton of antepartum, post partum and gyn patients. After the ward rounds i went to clinic to see patients and then after clinic I went to ultrasound to scan a dozen or so patients.
Yesterday was a OR day. Did 4 hysterectomies (three vaginal hysterectomies and one abdominal hysterectomy) plus one cerclage placement. I took a short break for tea and bread around noon otherwise was busy in the OR operating all day. Was pretty tired after operations but still had more to do..... about a dozen or so patients were waiting in clinic and a few waiting for ultrasound. I was happy to be finished with all of the work by about half past 6.

The short rains are starting to come. Its nice because the weather cools off and we get a nice breeze from the ocean. The rains and the wind are causing a ton of my mangos to ripen and fall. This moring I went around picking up mangos in my back yard. I found thirty-two fresh mangos....... it felt like I was on an easter egg hunt. (Not that I have much experience in easter egg hunting:) but now I know what that's like). There are so many mangos that I end up giving most of them away. Otherwise if I eat them all I'd end up with some sort of mango toxicity!

In two weeks I'll be traveling to Dar Es Salaam for the annual VSO conference. Its a 3 day conference for all of the volunteers in Tanzania to come together to share stories about the work that's being done and to discuss issues during the past year and talk about future plans. Definitely looking forward to the conference.

Hope everyone is well at home and enjoyed Thanksgiving! Till next time......Badaaye (Later...)

In and around Lindi

View from the 'sokoni' (market). There is a roundabout in front of the market and one of the largest banks in town, CRDB, is visible in the distance, opposite the roundabout.

Sokoine Hospital. N.B. The wards and the outpatient rooms are usually filled with patients and their relatives, whom are not present in this picture.

Mitema Beach is about a five or ten minute drive north of Lindi town center. Its a nice beach to go to if you are looking to veg out.

COTC Teaching

I spent an hour this afternoon teaching the third year COTC (Clinical Officer's Training College) students. Lindi has a COTC which awards its graduates a certificate to become an 'Assistant Medical Officer'. The College is a 3 year program with approximately 130 total students. There are 43 students in the third year class and I think all were present today for my lecture on "pelvic masses". The semester will end in January and the students will graduate in July.
For now, the COTC principal has selected 7 ob/gyn topics for me to teach the students during the remainder of this semester.

Compared to my last class of nursing students, teaching at Lindi's COTC is much nicer because the students have a better fund of knowledge and clinical understanding. In addition, the students are much more capable of understanding my lecture in English! No translator is needed....

The students rotate in the hospital and are always hanging around the maternity department - in the wards and in the OPD. Some students are good, some are not so good just like back home in US medical schools. The other day I sat with one of the students in the OPD. The first patient came with a history of post menopausal bleeding. The student asked me 'what are the causes of post menopausal bleeding'? I told him to read and give me the answer by tomorrow. He told me he doesn't have a book. There was a moment of silence because I didn't have a justifiable response, so I gave in and just gave him a brief rundown on the causes. I wonder though, how much are the students really retaining by learning from lectures and handouts without textbooks? I don't think all students are lacking books, but I think the majority do not have the resources to buy textbooks. This is a problem and I'm not sure how I'm going to go about finding a solution because its difficult to find donations to purchase new textbooks! In the meantime, I'm resorting to repetition through handouts and the old-fashion chalkboard....which isn't necessarily a bad thing!

Murphy's Law on Life in Lindi

If it hasn't been written already, I'd like to add a new 'Law' to the famous 'Murphy's Law's on Life', that being: "Water will only leak from your toilets and sinks AFTER the plumber leaves your house". This was the case in my house the other day. After waiting all day for the plumber to arrive, he finally came and "installed" my water system. When the work was done, the toilets were flushing, water was flowing from the faucets in the kitchen and in the bathroom and the showers even had good water pressure. I paid the plumber 20,000 Tsh (about $20) and left to go to town to run a few errands. When I returned home I found water leaking out of two of the toilets in the bathroom into the hallway and into one of the guest rooms. Fortunately none of my possessions were damaged and the water didn't cause any damage to the house. I spent my evening mopping up water.

Fortunately I managed to get in touch with the plumber to inform him of the results of his 'brilliant' work, only to be told that he wouldn't be able to return to fix the problem until later in the week! I guess I should be fortunate that I now have running water, even if it is on the floor and in my hallways :)
(photo courtesy of www.greekshare.com)

Celebrating victories!

Time to celebrate! Like the majority of Americans I'm celebrating the news of the new presidential elect - Barak Obama. The news of his win on Tuesday was no doubt a historical event, and will be remembered as one of the great moments in history. For me its a little bit of a weird feeling to be living in Tanzania and watching coverage of the election so far from home. Albeit most Tanzanians are very happy with Obama's win, and most are celebrating but there is not the special feeling of unity and pride which I can imagine most Americans are feeling back home.

On a smaller scale I'm celebrating a victory of my own. Last night, for the first time in over a month, I took a shower! No, I didn't go a month without bathing, instead I was using the bucket over the head method, which was getting old very quickly! But after a month of persistance, patience and a little bit of luck, the plumber finally managed to fix my shower system and I can take a shower now like most of society, (although there is no hot water, but that is not something I can complain about!:) Its a small victory but a victory nonetheless and I was so happy to take a shower that I showered for almost a half an hour.....maybe I used about 500 liters of water or so, but it was definitely refreshing!

Its going to be a relaxing weekend. I'm planning to go to the beach, read and maybe go for a little swim in the Ocean. I received a bicycle from VSO the other day, so its much easier to bike to the beach (about 10-15 min. by bike) than it was before when I was using my two feet for transportation....

Raining mangos, a bloody dog, hospital news and trick or treators?

Its 2:00 in the morning and I wake up to the sound of a loud bang, like the sound of a gunshot. At first I'm startled, but then I realize that its mango season and a mango has just fallen from the tree and hit the roof of my house. Mangos are falling all around Tanzania this time of year espically from the 5 mango trees in my backyard. The loud noise is unsettling to wake up to, to say the least!
November and December is peak mango season. Little kids have been threatening to climb the fence and steal mangos. I don't really mind if the kids take a bunch of mangos because there are so many to go around....

Two days to go until the big day. Everyone here is talking about the election. Everyone's asking me who will win....Based on the polls its obvious now, but electoral votes are different and it looks like both Obama and McCain are concentrating on swing states. I'm guilty of not registering at the American embassy in Dar Es Salaam so I won't be able to vote.

My three dogs are doing well, but I'm getting concerned about Obama. For the last two or three days, he hasn't been himself. The other morning I saw a few drops of blood outside my door. Then I saw a broken light bulb sitting in the dirt, next to where he was sleeping :( He was foaming saliva out of his mouth this afternoon and decided he wanted to be by himself. I hope he feels better soon. And most importantly I hope its not some sort of a sign of what will happen to Obama, the presidential candidate!:)

Work is going well. One of the AMOS in the Ob/Gyn department is taking his annual leave next week. That will mean more work for me and the other AMO working in the department. More cases to do in the OR and more time to spend in the ward. I don't mind at all, treating the patients here is very rewarding and there is so much pathology....

No trick or treating for me this year. Halloween doesn't exist in Tanzania:( I have to live vicariously through the pictures of all the halloween parties posted on facebook! Looks like everyone had a good time, some people more than others!

Marking their territory

Don't let their innocent faces fool you. These dogs have their own agenda and are becoming attention seeking, hyperactive, and severely dependant.
The other day I made the mistake of inviting the three of them inside my house. They were hesitant at first but after a few small fish treats, they made themselves at home. This evening, the three dogs snuck in through my front door. Bush starting gnawing away at my table, McCain was sniffing around under the sofas and Obama was busy urinating in front of the bookshelf! I sent them outside and locked the door to punish them for their unacceptable behavior!

On a separate note, work's going well. Its been busy with many patients! This afternoon we had an emergency c-section due to acute heavy bleeding in a 7 mo pregnancy due to placenta previa. Fortunately the baby did well. We took another patient to the OR this afternoon for currettage due to retained products and suspected placenta accreta after a normal delivery.

Tomorrow's a ward round day and Friday is supposed to be another OR day but there is a visiting surgeon in town from Dar Es Salaam who is operating for 3 days.

Unsettling week a bit because I lost my cell phone. I'm pretty sure I left it on the table in the guest house in Ndanda last weekend. I realized my phone was lost when I woke up from a nap on the dala dala (small bus) back to Lindi. At first I thought the guy sitting next to me stole it, but I checked his contact list and saw unknown list of people. So I figure that my phone must be in Ndanda. And there's no answer when I call so its looking like I'll have to buy a new phone :(

Jioni njema na kwa heri kwa sasa (Good evening and good bye for now!)

Sikukuu

Today is a sikukuu (holiday) here in Lindi. I'm not sure if its a national holiday or just a regional one, and I'm not sure what the holiday is celebrating. In any event I went into work today to check on the patients.

This morning my hospital driver didn't show up (because the hospital car had a "flat tire") so I started walking to the hospital. Half way to the hospital I ran into the electrician who was on his way to my house to install wiring to fix the water pump.

I turned around and walked back to my house with the electrician and waited while he installed the wiring (surprisingly only took him about 15 minutes). When he finished, I called the hospital and requested that a car come pick me up. By about 9:30 a driver came and took me to the hospital.

Arrived in maternity department and was surprised to see one of the assistant medical officers in the middle of examining a patient. I figured on a sikukuu he would be at home "resting" but I was pleasantly surprised. He is very committed and motivated to give good patient care....

The patient he was examining had a full term pregnancy with the fetus in footling breech presentation (in other words, the baby was sitting upright in the uterus with one of the legs extended and foot protruding through the cervix). Luckily there was no cord prolapse and the fetal heart tones were normal so we took the patient for a cesarian section.

Usually the anesthestists and nurses are really good about being efficient in transporting the patients from maternity to the OR and they were good again today; however, being a sikukuu today we had to call the anesthetist in from home.

Long story short, we waited about an hour for the anesthetist to arrive. Luckily the baby did fine with good apgars....

After the c-section, we had one post partum tubal ligation to do. The assistant medical officer told me he does this procedure under local anesthesia. I was surprised to hear he does this procedure under local, as I have always done this under spinal. I watched to see how much pain the patient would have and like I had expected, the patient had more pain once the AMO entered the peritoneal cavity; however, she didn't seem to be in a whole lot of pain.... After the tubal ligation, the patient walked back to the ward by herself:)

I passed back to Maternity to check on everything, and things were quiet, so I went back to reception to wait for the driver to take me back home. The driver almost arrived when a nurse said that two patients needed ultrasounds.

The first patient was really sick! She delivered a nonviable baby at another hospital about three weeks ago. Now she came with fevers, nausea/vomiting, abdominal pain and a very distended abdomen! The ultrasound showed very dilated loops of bowel suggesting an ileus. We admitted the patient to receive antibiotics and to get a nasogastric tube.....

The next patient came with abdominal pain and a large pelvic mass per the chart - the ultrasound showed a intrauterine pregnancy of 22 weeks. The patient was admitted for a further workup......

I went back home and fed my dogs (Bush, Obama and McCain). Then called for transport to take me into the town to run a few errands.

This weekend I'm going to go to Ndanda for a regional meeting. Just found out there was change in venue. I'm looking forward to returning to Ndanda and seeing everyone (almost everyone) and my old house......

I'm heading to a restaurant down the street to eat nyama ya kukuu and chipsi (chicken and chips).....next time I'm putting up pictures of my new dog Bush (who btw has had a bloody nose for the past two days:() She still wags her tail everytime I see her - nice of her to pretend she is happy to see me.....

TGIF

Thank g-d its Friday! Its been a busy week, not only at work but at my new home.
At home, I like to think I was pretty productive. I managed to get internet access, a plumber and new furnishings to make the place more homely. I still don't have running water, but the plumber promises by next week, the pump and water will be functioning. I like his optimism but I won't be holding my breath; I take what most people say around here with a grain of salt.

At work its been really busy. Which is good. I've been enjoying the work! I feel lucky to be working at a hospital which had two European gynecologists working in it for the past 4 years. There is a real Ob/Gyn Department. Now we are three, but the nurses are well trained as are the Assistant medical officers. There is equipment which is functional and staff who are capable of using the equipment. Unlike the previous hospital I was working at, there is a cervical cancer screening room as well as a radiology department which hopes to begin mammography soon.

The Assistant medical officers have been trained to do gynecologic surgeries and I think they are have more surgical skill than alot of graduating residents in US. That is not to say as a generalization that US trained gynecologists are undertrained by any means.

This week I spent the majority of the time in the clinic (outpatient department). Typically seeing about fifteen to twenty patients a day. The patients are a mix between obstetric and gyne patients, with all of the same complaints I'd seen during training - infertility, gynecologic malignancy, general gynecologic diseases, STD's, pregnancy related complications, etc.

When I'm not in the clinic I'm in the ward or operating room. This week I had two hysterectomies for symptomatic fibroids. The first was a very difficult case! The woman had a large fixed mass the size of a twenty week pregnancy. Probably complicated by pelvic inflammatory disease, the mass was fixed to the bladder and peritoneum with thick adhesions. She lost a lot of blood required two units of transfusion but had an unremarkable post-op course.
The second patient for hysterectomy also had symptomatic fibroids, but a smaller, much more mobile uterus, which was much easier to remove without any complications.

The language barrier is slowly breaking down, I mean its becoming much easier to communicate with patients in Kiswahili. Although much of what I say is the same to every patient, I think listening and communicating with people in Kiswahili makes it easier.

The doctor-in-charge of the hospital is the only functioning "radiologist" in the hospital, and he's been away at a meeting for the past few days so I've been doing a ton of ultrasound. I enjoy this because I never had a chance to perform much gyn ultrasound during residency, aside from first trimester family planning ultrasounds.

Oh, I almost forgot, I have another dog. Now that makes three. Her name is Bush. She is two months old and much bigger than my other two dogs - Obama and McCain (who are slowly getting bigger). Bush came to me about a week ago. She ran away by sneaking under the front gate the first day. She found her way back home about a few miles away. The owner brought her back a couple of days later. She snuck under another fence the next day and went back home. I was thinking of naming her Houdini for her disappearing acts but I like Bush better. She is very well received by Obama and McCain who are very happy to have a new friend.

Its going to be a relaxing weekend here in Lindi. Plan to go to the beach and swim tomorrow. Next weekend I'm going back to Mtwara for another going away party.
Hope everyone at home has a nice, relaxing, enjoyable and fun-filled weekend!:)

Obama and McCain in Lindi, 3 weeks old

I got two dogs. Named Obama and McCain. Don't ask me how I came up with the names, I just thought it would be a good idea to name the dogs after presidential candidates! That is Obama on the left, lying down and McCain on the right sitting up. Obama and McCain are brother and sister, Obama is a boy and McCain a little girl. No pun intended! They are both 3 weeks old!

The puppies arrived two days ago from a friend at the hotel I had been staying at. When they arrived, they looked so weak and helpless they curled up next to eachother inside their dog house and just slept. They are so afraid of me!
They did get a good meal of Ugali and small fish yesterday (Ugali is a staple Tanzanian food that is sort of a stiff porridge). People here eat it every day together with beans or vegetables, or meat, however, I've had no desire to try it. However, Obama and McCain love ugali and fish. After they finished their meal yesterday, I let them out of the dog house and they started to explore the backyard a little bit.

McCain seems to have more of a "curious" personality. She is always searching around and looking at me wondering who the heck I am and what the heck she is doing in my backyard!
Obama seems to be more relaxed and confident. Again no pun intended! He is more playful and yesterday he was rolling around in the dirt, I was thinking of stopping him, afraid he would get so dirty and get flees, but I just let him be.

Both puppies slept most of the day today. It is a sikukuu (holiday) here in Lindi today. I didn't have my household helper Hadija today so I had to go to the hotel and request ugali for the dogs. I gave them their food but they didn't each much. After a couple of hours I decided to add the little fish that Hadija bought from the market and then the dogs gulped down their food. Seems like Obama and McCain are a bit finicky with their diet, hahaha:)

That's about it from here. Hopefully will put up more pictures of Obama and McCain next time!
Also I am hoping to get internet installed in my house this week so I'll be able to skype and have time to write more without paying the hefty internet cafe prices.
Hope everyone is well at home!

New house in Lindi

I like my new house. Its pretty spacious - 3 bedrooms, two baths, living room and kitchen. The water isn't working yet, but hopefully the plumber will come on Monday. The house is mostly furnished, there's sofas in the living room and bed and dresser in the bedroom, but i'm still waiting on a couple of pieces of furniture to come this week.

I love the backyard, its really a lot of space. There are two mango trees and two banana trees. In one of the pictures you can see the back of my house from the the backyard. In the front, there is a little cabana like house that is supposed to house the "askari" - guard, however, I haven't hired a guard, yet, I like to use this space for outdoor cooking or reading, etc.

There's a dog house! Sadly, though, they told me that my dog ran away! I was so sad to hear this bit of news. Though at least i won't have to worry about feeding a dog or listening to any barking noise at night. If I find anyone selling puppies, i might have to get one.


The pictures above = the little cabana like space in the front yard where an askari can work (= sleep). The other picture is the front of my house.

There is a large gate that surrounds the house and the white gate with black doors is the "front" of the gate.

Above = the dog house. The picture above the dog house is a view of the back of my house from the backyard. Its probably a hundred yards of space surrounded by a gate.

Mangos waiting to fall. There still not yet ripe, maybe by next month

banana trees

The bed in the "master bedroom" The two other bedrooms do not have furniture in them yet, hopefully this week.

Work, weather, life, and other frustrations

Work has been going well. But very busy. Worked in clinic last two days and felt like i saw about one hundred patients. Had one case in the OR - a salpingectomy for a ruptured ectopic pregnancy. Tomorrow we have four cases scheduled, two VVF repairs, one hysterectomy and one anterior colporraphy. Hopefully we will have electricity because the last time we tried operating, the electricity went out in the middle of the case.

It is so hot!! By 9am it feels like about 100 degrees. This morning the hospital driver forgot to pick me up at the hotel so I walked to the hospital. Only a 15 minute walk but it was uncomfortable to be in the sun for that long! I'm trying to remember to consciously drink extra water because its easy to quickly get so dehydrated here!

Finally saw my house! Its nice! 2 bedrooms, 2 bathrooms, kitchen, etc. The house is almost on the top of a very large hill/very small mountain. maybe 300 or 400 feet above sea level? Its about a 15 minute drive from the hospital, the first 10 minutes is a drive up a very steep hill.
House comes with a dog. Have yet to see the dog, but looking forward to meeting him/her!
Too early to tell if electricity will be a problem, but seems likely that it will be an issue.

People are very friendly here! But sometimes they stare at me like i'm a alien from another planet with 3 heads. Its not too bad in the hospital because people assume i'm a doctor, but in the city, there are very few wazungus, so if people see a white guy, they definitely give you an extra long look!

My diet hasn't been great. I've been eating two meals a day because its been so busy during lunch time, i skip lunch. I eat a hard boiled egg and bread with margarine for breakfast and dinner is local tanzanian food which can be very tasty but usually is fried and unhealthy. There is one new very nice hotel which seems to have a nice restaurant but I haven't tried the food yet.
Solution seems simple. I have a "household helper" who is waiting to come and help take care of the house and who also is capable of cooking! And the market in town has some good looking vegetables. The fish is very fresh and there are plenty of butchery's scattered about.

That's it from here! Hope everyone's well back home.

Hotel Chemi Kumi and Hospitali Sokoine

I've been staying at the Hotel Chemi Kumi for the past week.
The hotel is located right on the beach with a beautiful view looking out into the ocean. Often spend quite a lot of time, while away from work, sitting at the restaurant chilling out, relaxing with a drink. Its so hot during the day that its nice to get a cool breeze from the ocean to cool you off.
There's a family who owns the hotel and the children and their friends manage everything and do a very good job. The kids do everything - cook, clean, wash clothes, etc. The other day there was a party at the hotel and about a hundred people came for the party. Local tanzanian flavor music was playing all night.
The rooms are small but "cozy". There is usually no running water so I shower pouring water from a bucket over my head:) At least the water is hot:)

Electricity is an issue, in town and at the hotel it usually shuts on and off and the most unpredictable times.
Work has been going well. Spent the last couple of days working in the clinic. There are enough patients to keep me busy until mid afternoon. I usually finish work at 3pm if its a light day or by half past 6 on a busy day (last Thursday). Normally every Wednesday and Friday the Ob/gyn department has cases scheduled in the OR but didn't have any cases to do today. The main OR is under construction so we have been using a temporary OR near the eye clinic. The other day the electricity went out in the middle of a c-section. Luckily i had some light coming in from the window close by the OR table and we were closing the abdomen when lights went out, so it wasn't too difficult to finish the case:) but i'm not sure what happens when lights go out at night during a c-section. One of the nurses said that the anesthestist shines light from a cell phone onto the field to help the surgeon see. I'm not sure if she was joking or serious but wouldn't be surprised if she was serious. Fortunately there is a generator in the hospital so I think that the generator usually functions during the black-outs. There's also a lantern sitting in the changing room but i'm not sure if it works.
The hospital actually had 2 Gynecologist from Holland working up until last month. One of whom worked in the hospital for 4 years and made a very large contribution to the hospital - taught staff, brought in a ton of equipment, medications, and even started 3 research studies. Its definitely nice to have some foundation upon which to hopefully build upon. One of the Tanzanian medical officers was trained in some gyn procedures and now is capable of doing VVF repair and a few urogynecologic procedures in addition to routine general gynecologic cases.

The pictures are from Hoteli Chemi Kumi, and view of the ocean.

Lindi

Things are going well here in Lindi. Arrived Wednesday evening and met the Doctor-In-Charge of the hospital at a hotel where I'm staying for the next couple of weeks until the house that I've been assigned to is ready. Spent the day yesterday becoming familiar with the hospital and meeting a ton of new people. Again today, spent the day getting to know people and had first case in the OR - Anterior colporraphy for cystocele.

One of the biggest challenges is going to be to improve my Kiswahili, because fewer people speak English here in Lindi compared with Ndanda, so I'll need to get a better grip on speaking in Kiswahili - it will definitely make things much easier.

I've decided this blog will be a short one, the internet connection at the internet cafe here is decent compared to those in Dar and up north but its at least twice as expensive and I'm quickly running out of minutes!

Tomorrow afternoon I'm going to Mtwara. I'm going to take a Dala Dala (overcrowded minibus) to meet a bunch of other volunteers for Renee's farewell dinner. Renee's been working as HIV doctor for a gov't hospital in Mtwara for the last two years.
Will hopefully write more this weekend.

Arusha National Park

What a way to end a mini vacation up north - on safari in Arusha National Park! Spent the day yesterday enjoying the sites of Arusha

National Park. The park is one of the smaller parks among the Game Parks in the Northern Tanzanian Circuit but it was more enjoyable than the last safari I went on in Mikumi National Park. Arusha NP is supposedly the only park where you can get out and walk/hike around, which we did for a couple of hours and were able to get much closer to the animals than we had been in the car. You won't be able to see all of the "Big 5" (Lion, Rhino, Elephant, Giraffe, and Leopard) here but you will be able to see a bunch of giraffes and baboons and if you are lucky a few elephants. Also impressive were flamingos and eagles above the lakes.

My tour guide Guardan led me and two other "mountaineers" :) throughout the park carrying a loaded gun. The buffalo is the only predator in the park that would potentially attack people. Guardan has been working as a tour guide in Arusha NP for 5 years and he has only had to fire the gun once! We were glad we did not make it number two.

Arusha NP is more 'hilly' and 'woody' than Mikumi National park and is much smaller, but has beautiful sites - its known for the Ngurdoto Crater and the lakes - we saw a couple of hippos sunbathing out of the lake but from quite a distance. Also caught glimpse of a group of flamingos and eagles soaring but was difficult to photo despite my advanced training in photography:)

above: Kilimanjaro peak (~5900 meters/19,000 feet)

below: Twiga = kiswahili for Giraffe

above: family of giraffes. The male giraffe has two horns on the head, the females can be recognized by the hair standing up along their backs.

below: the waterfalls - source of water from Mt. Meru. That is Emily in the picture - she was on safari with her boyfriend James from the UK. Nice couple.

above: a herd of buffalo - the only animal that would potentially attack us. Apparently we didn't look very appetizing or the buffalo were not hungry during our safari

More Twigas

above: pair of twigas (male and female)

below: couple of hippos sunbathing out of the lake

above: Ngurdoto crater - a "mini Ngorongoro crater" the base is mostly swamp land. We saw a herd of buffalo way out in the distance, too far away to photo.

below: twiga on break

The baboons. While we drove past a large group of baboons up in the trees we caught a brief shower of baboon droppings through the opening in the roof of our car, making baboons a dangerous animal for a different reason.

above: pundamilia is Kiswahili for zebra

I'm back in Dar Es Salaam now. Will meet with my manager tomorrow and then fly South to Mtwara on Tuesday.

Looking forward to finally getting settled in a house and starting my new post in Lindi.