Watoto Wamefurahi

Excellent weekend in Mtwara! After a 4 1/2 hour dala dala (overcrowed minibus) ride, we arrived in Mtwara. Made a brief stop at the guest house to drop off luggage and then to Ellen's house for Rose's "going away" BBQ party. We ate barbecued fish and beef kabobs, with salads, fruit and chocolate cake for dessert. After dinner went to the "Boka Boma" - Tanzanian style night club/bar for live music and dancing..... The music wasn't great compared to other live bands here, but company and ambience was enjoyable and the dancing was a lot of fun....I realized that I need to work on my dancing rhythm a bit though. The "Bongo Flavor" African music is a bit different than American tunes as you might imagine:)

Awoke early Sunday morning; we left the house by 7:30 am to head to Msimbati - where the nicest stretch of beach in Tanzania lies. Msimbati is 42 km south of Mtwara, and there is an area of beach with guest houses that you can visit for 12,000Tsh. We arrived in the morning, ate breakfast and then headed into the ocean to snorkel.....

Low tide came around 11:30. I spent only 20 or 30 min. in the water because of a bad burn last time out, but the snorkeling here was excellent! The coral is very "healthy" and water very clear and in low tide you can snorkel right up against some of the most beautiful marine life in East Africa....

Heavy raine came by mid afternoon, so we had lunch together in a covered patio area.....fresh fish and lobster with fries.

Sunday evening was quiet - "carry out" from the Karosho - a chicken curry, prawns, garlic naan, rice and salad....finsished by about half past nine and called it an early night.

Today slept in, then went to the fish market. Was hoping for some fresh kingfish but the selection of fish was not great. Either we arrived too late, or there was not a good stock of fish for sale today. I wanted to experiment and add to my cooking repertoire, so I bought 3 small fish....

In the afternoon we went to the market. Bought 3 new DVD's, NIDO (powdered milk) and a new box of wine. Then had more fish for lunch in Mikindani at a little bar on the side of the road. We were back in Ndanda just shy of 6:30. Although still full from a late lunch I did go to the Abbey guest house for dinner....If you can't tell already, I am very satifsfied with my diet the last frew days!

Pictures: (from top down):The first 3 are little children on the side of the road in Mikindani. They are fascinated with Wazungu's (white Europeans) and were screaming "piga picha" (take a picture) so I took a few pictures. The little kids love to see themselves on the camera and then start screeming "tena" (again!). I was about to get carried away taking pictures, until one of the parents came by and helped take the kids away. Fourth down is the fish market in Mtwara. Fifth and sixth: Amadi and his two older sisters. Amadi is a 10 year old boy who was walking along the beach this morning with his two older sisters. I asked Amadi to smile but instead he struck a professional pose with head tilt:)

Last picture is of my friends/neighbors/colleagues here in Ndanda aka the VSO family of Ndanda. Left to Right - Diane - Community Home based Care coordinator. Doctor Francijn - HIV/AIDS medical doctor. Myself, and Sheena - lab tech :) We are at lunch at a little bar restaurant in Mikindani.

City slickers, part two

I worked up an appetite today...... It was not too busy at the hospital. One D&C for a missed AB, along with a fair number of gyn patients, but no major operations and no cesarian sections. It wasn't until mid afternoon that I consumed most of my energy....

It was about 3:30 this afternoon when I made a return trip to the local bank to ask if my "predeparture allowance" check from VSO has cleared yet. Long story short, the check hadn't cleared yet, but the point of the story - As I left my house and turned towards the main road I saw a large herd of cattle passing by. Usually if I'm heading to the market at this time, I stop and wait for the herd to pass, but due to the rain and lack of patience, I jumped right in the middle of the road and found myself neck and neck with two of the largest cows I've seen here....One of the cows stopped to relieve itself in front of me; good news, I avoided further disaster, bad news its the topic of this blog, sorry:) And, it led me to start thinking, how did I manage to get myself in such a predicament?

It was just 1 year ago I was working in Chicago, finishing my ob/gyn residency, about two months from graduating......little did I know that a year later I would be walking in the midst of a herd of cattle dodging feces in pouring rain in a small town in Tanzania:)

Joking aside, I am still very happy here, despite all of the "challenges"..... I've managed to stay healthy, avoiding further tropical diseases like Malaria or Cholera, and still finding the work to be very rewarding! Though I do miss my family and friends back in the states!!

On a separate note, I am looking forward to another mini vacation next weekend in Mtwara as we're heading to the beach house. Then in about 3 weeks I will return to Morogorro for "intermediate" Kiswahili language training.....something I am definitely looking forward to. Until next time. Salama (Peace:)

BTW picture above taken in Mtwara as a herd passed by, don't have actual cows from today but this is close.

Baby Steps

The past few days have been a blur.....work wise it has been really busy. Was on call Monday - started the day with a TAH (total abdominal hysterectomy) for symptomatic fibroids, followed by salpingectomy for ruptured ectopic. Call itself was busy until about 11 with two cesarian sections. Then received the dreaded call at 4:30am from male surgical ward to see a man who was in a fight with severe lesions to his scalp and small skull fracture. We brought him to the theatre for surgical toilet but he died today, probably large intracranial bleed.....

Yesterday as well as today were both fairly busy....one ruptured ectopic yesterday and another today (total of 3 ruptured ectopics in the last 3 days).....either I'm a ruptured ectopic magnet or there is a much higher incidence of ruptured ectopics in southern Tanzania; i think the latter because there is definitely a higher incidence of PID (pelvic inflammatory disease) here which is a risk factor for ectopic pregnancy!

A little bit of excitement today.....one of the doppler ultrasounds arrived from Dar (Hospital administrator brought one, the other two will arrive by truck). I introduced the doppler to the nurses and other doctor working Maternity department. The look on their faces when we tested the doppler on a laboring patient and heard the fetal heart rate was like the look of excitement a child would have opening up presents on Christmas!.....Although this doppler is a bit different than the one I had anticipated, it works fine and in my opinion will greatly improve monitoring of fetuses in laboring patients, so we can reduce infant morbidity and mortality. I feel like receiving the doppler ultrasound will be a big improvement in our level of care, but still we are making baby steps in larger goal of reducing maternal and neonatal morbidity/mortality.

On a separate note, just finished one of the best meals I've had since arriving in Tanzania. No, I didn't find a new restaurant, this meal was home-made......not by me of course. I invited two of the nurses from the maternity deparment to my house to cook and try to teach me how to cook. After about two hours of preparation and cooking they made a delicious rice pilau with meat and potatoes.....the flavors with onions/tomatoes/lime juice was excellent and they made enough food to last weeks..... While they were busy cooking I was busy taking notes and trying to remember how to prepare this meal. Its doubtful whether I can reproduce what they made, but nonetheless was an interesting experience and helped improve my Kiswahili cooking vocabulary if nothing else! When the food was ready, we ate the rice pilau/beef and potatoes along with a couple glasses of wine. Asante Waguuzi toka Wodi nane! (thank you nurses from Maternity ward!)

Picture above was taken in the late afternoon from the outside of the guest house in Ndanda where I normally eat dinners. There are a bunch of houses beyond the palm trees, sort of a little village where a lot of the hospital employees and families live....Only a few houses are visible but I liked the reflection of the sun against the "forest" of trees in the background.

10 degrees South

Excellent weekend in Mtwara. Arrived Friday evening and had dinner at "10 degrees South" a nice restaurant a bit down the road in Mikindani. Named after its location on the globe, "10 degrees south" :)

Our favorite destination for dinner, "Southern Cross" unfortunately literally burnt down! A bad fire in the kitchen left the restaurant roofless! What remains are charred coral walls and a patio where guests used to sit and overlook the Ocean.

Seems the second best spot to eat in Mtwara is "10 degrees south" because by the middle of our meal the regular crowd from Southern Cross had made it to "10 degrees south". About a half dozen Canadians from another development agency are regulars at Southern Cross. Last Friday night we spotted them at "10 degrees south!"

Saturday was a great day....... The tide was at its lowest around noon so we went snorkeling.....excellent snorkeling weather....the coral was very "healthy" and the skies were clear so it was easy to see all of the amazing marine life that live around the coral reef! This time no jelly fish. I was however, a little concerned because after we first set out, my nextdoor neighbor said to me "watch out for the lion fish - they are a bit poisonous!" "Where?" I asked. "Right below your feet!" she said.....I didn't see them, but fortunately I was reassured because apparently you can't die from them, just get a little shock :)

We spent the afternoon shopping in the town. Unfortunately the Makonde Mini Market was closed, as was Eco Eco (our local liquor store) so we drove a little further into the town. I found a couple of new DVD's to buy and the others bought fabric and found a tailor to make clothes.

Saturday, 5pm we went to the Karosho (cashew nut) Restaurant to have our semi-annual VSO Mtwara regional meeting - a meeting for all volunteers based in the Mtwara region to discuss issues arising within the placement or with VSO...... Topics of discussion - at the top of the list - "Mtwara Region Evacuation Plan" - Basically all groups of vols have to come up with an evacuation plan in the event of an outbreak like Avian flu or Ebola or if there were to be some type of civil unrest.......after some discussion we could not come to a concensus but a few "good" ideas were suggested: head south to Mozambique, or better, take a small raft out into the middle of the Indian Ocean and hope we make it some place safe like.....Holland? (inside joke to those who have seen the TV series "Prison Break"). There is actually a photo of a small log raft along the shore in Mtwara, that we might send in to VSO office to document our "evacuation plan."
Other topics during the meeting - issues with housing - of which the people based in Ndanda have none because we are fortunate to have running water (hot and cold), electricity and internet! Others in Mtwara are less fortunate :(
Another issue discussed was "Gender Mainstreaming" - a topic VSO likes to discuss. A thick document was placed on the table outlining "gender mainstreaming" and incorporating into placements..... I made a comment "I don't completely understand how to integrate "gender mainstreaming" into my placement" - I did get an answer but I am still a bit confused.....I was told that at the previous semi-annual meeting, to better understand "gender mainstreaming" each volunteer had to stand up, say their name and state their gender. Fortunately we didn't have to do that activity this time:)
After the meeting we had dinner and drinks and hung out at the restaurant for a while. Some wanted to go to ?Bokaboma? a night club for more drinks and to listen to live music. I was tempted but we couldn't get a large enough group and I knew I would not be able to find my way back to the guest house after more alcohol. Maybe next time.
It was a lazy day today.....I skipped snorkeling because despite applying my spf 30 suntan lotion yesterday I developed a bad sunburn on my back and legs.....so I spent the day in the shade reading. We drove back to Ndanda around 2:30...... and made it back around 5 because of a short stop at the airport to pick up a guest of my neighbor from Germany......
Back to work and on call again tomorrow. I'm sure it will be interesting/entertaining as always! Hope you had a good weekend! Badaaye (Kiswahili for "later...")

Hurry up and wait

Yesterday I was on call again, and as expected it was an interesting call day.
Technically call starts at 4 pm after the rest of medical/surgical staff has left for the day. The "on-call" doctor is released from duty at 1pm to "rest" then to be available on call from 4pm until the next morning at 8am.
So, at 1 pm instead of "resting" I promptly rode my bike back to the NMB bank, Ndanda branch to ask why its been 10 weeks since depositing my predeparture allowance check and it hasn't cleared yet. The manager told me that the check has to be first sent to Standard Bank and from there a courier has to hand deliver the check with funds back to NMB. He told me he is certain that Standard Bank has received the check but wouldn't give me any details of when or who received the check. I asked him how he knew the check had been received. He said "you have to trust our system." I was so frustrated I typed out a letter requesting names and dates of the check arriving at Standard Bank but the manager refused to sign. I insisted on a name and number and, long story short, after 2 hours of debate I finally managed to get the name of his boss and number to NMB in Dar es Salaam. Luckily the manager spoke english and confirmed that my check arrived at Standard bank January 28th. Why it hasn't cleared yet is another story......
Back home by quarter to 4 just in time to get a call from Maternity Dep't to see a patient. Previous c/section due to failure to progress in active labor. In the midst of examining the patient I got a phone call from the hospital administrator (who is in Dar now buying equipment for the hospital including the doppler ultrasounds purchased back in December) informing me that the dopplers I thought were purchased are completely different than that expected and require a headset to operate!! After an unsettling conversation I went back to resume examining the laboring patient when another nurse came in to say that the theatre staff is waiting for me in the theatre to do the Ectopic pregnancy......."what ectopic pregnancy" i said. They said the patient for "emergency ectopic" is on the operating table now and they are waiting for you.......
I stopped my exam and headed towards the theatre when the maternity nurse said to me, "wait can you please examine this patient with placenta previa that came in bleeding?" "what previa?" I said. "The patient with a placenta previa who is bleeding" replied the nurse. I looked down at the patient's perineum didn't see any blood and made a decision to go to the operating room to do the "ectopic" as a priority.....
In the operating room, everyone was gowned and ready to start the operation. I looked at the patient who was about to be intubated and saw she was lying comfortably in no acute distress. Her abdomen was nondistended and nontender. There was a large keloid scar from a prior ectopic pregnancy. I looked at the anesthesiologist and said "who made the diagnosis of ectopic pregnancy?" He said "the patient". "The Patient!" I said??? I don't understand. Then I looked at the chart and the general surgeon had indeed examined the patient, scanned her and found an ectopic pregnancy and wrote plan for "emergency laparotomy at 4pm".......what a way to find out about a patient I thought!
I was reluctant to operate given her exam findings, however indeed there was an intact ectopic pregnancy that I removed, uncomplicated. why it was an emergency I don't know.......So, I rushed back to Maternity to find that the previa was infact bleeding, but not acutely hemorrhaging. So I made the decision to do immediate c-section for bleeding placenta previa at term. Emergency c-section again turned into a wait of almost half an hour. Long story short, the nursing students are expected to place lines and foley catheters and the student on call was having difficulty starting the IV and placing a foley catheter, so we had to sit around and wait..... Fortunately the baby did well with apgars 9,9 and mother was stable after the operation.......
Returned to maternity department where the patient with previous scar had delivered, but baby died - chronic asphyxia!
By the time the chaos had quieted down it was 7pm and I was back home. Hungry, tired and without much food to eat. I finished off the popcorn I saved from last month, made 2 scrambled eggs and drank some milk for dinner.
After a frustrating debate at the bank and then two operations I was a bit tired. I went to sleep early around 9, but woke up around 10 by a call from male surgical ward. This time a patient came in after a bicycle accident with wounds to his chin that required suturing. Back in the theatre suturing the wound and home again around 11. Fortunately this time slept through the night.
Uneventful day today......Tomorrow making another attempt at Mtwara for R&R while I have the weekend off.

Picture above is a view out the window of the office in Maternity Ward. Its about 1pm and typical of most afternoons - the patients are sitting outside ward 6 - the female surgical ward. Most of the patients in this ward are post-op and spend most of the day time resting or visiting with their families and friends.....

Good Read

A very good read, just finished "My Traitor's Heart" by Rian Malan - a South African author.

Read it to get a better understanding of the history and culture of South Africa during the time of Apartheid conflicts.

This post was inspired by reading one of the "blogs of note" - "People Reading". Check out http://peoplereading.blogspot.com/ - very interesting blog about what people are reading today in San Francisco.

Next on my list of books to read is "The Camel Club" by David Baldacci, one of my favorite authors. "The Camel Club" and "My Traitor's Heart" are both owned by the hospital administrator here in Ndanda, who was kind enough to lend to me....

A new look in Africa

Ok, I hear all of you out there chuckling....

Here is the story - No, I did not loose a bet, nor did I watch the movie "Borat" too many times.....actually I've decided on this new look because of requests. Believe it or not, besides a little bit of praise and admiration, the response and request I received from many people upon sharing the news that I was moving to Africa was to grow my hair longer and stop shaving.....

Well, actually - I'm sorry to inform you that this is not a "real" picture. Thanks to the "paintbrush" I was able to "enhance" my image a little bit. Yes, despite the fact that I don't have a social life here in Ndanda; nor do I have any good friends or family in Africa to be seen with, the best I can do is pretend :) sorry. (****Actual photo is in the previous post****)

Ellen, don't worry, I won't come to the wedding looking like this......that is because I doubt the customs officials at O'hare would let me past security, sorry! :)

***To friends/family/colleagues - please don't be concerned about my mental well being, I haven't lost my sanity (yet), just having a little bit of fun:) ****honestly.

5 months

Greetings again from Ndanda! Most importantly from a more familiar face :)

It was such a lazy/relaxing day today that I spent some time experimenting with the tools on the computer webcam and found out how to attach this "golden" frame to my picture:)

So, 5 months since I arrived in Tanzania.....it doesn't feel like it; seems like time has flown by, like it was the other day I was living and working in Chicago.....actually I have been having this recurring dream where I am back in the States and wondering how and when I will be able to return to Africa! (I don't know what my subconscious is trying to tell me!)

5 months in Tanzania.....technically will be 5 months on Wednesday (arrived October 5); 4 months since starting work at the hospital here in Ndanda. 4 months working in a rural hospital in Tanzania and what do I have to show for it? Escargot, a small crocodile and live chickens? :) just kidding....if you have actually spent the time to read all of the previous entries you might know what I'm talking about....

It rained for most of the afternoon, very heavy downpour for a few hours.... some of the loudest thunder I've heard. Didn't see any lightning but thought that the eye of the storm must have been over my house because it was so loud. Its been raining almost every day for longer periods of time...skies usually clear by 5 or 6 with much cooler temperatures.....

This morning I had a brief meeting with the hospital administrator to complete an application for funding for a "small scale project" that would in essence provide financial assistance to purchase new equipment for the maternity department in the hospital - such as fetal dopplers, a vaginal probe ultrasound and pulse oximeters....If the application is accepted, the sponsor would provide 8,000 Euro, the equivalent of about US $13,000 to pay for equipment..........

Back to work tomorrow and on call on wednesday. Off next weekend and will make another attempt at traveling to Mtwara.