hi friends, wanted to let everyone know we’re leaving for a maasai village tomorrow. we will be bringing tons of supplies and meds and spending four days running a clinic with two other students (one nursing and one still in college) and dr. lace. the village is very large and we’re going to be extremely busy as they usually only get medical care when we come. it should be a very interesting experience and I’ll do my best to catch up with the blogging once I’m back. we’ll have no electricity or anything while we’re there, so look for an update maybe by next week. wish us luck! this will be an experience for certain… I just hope they’re joking about eating goat testicles… miss you all!!
we’ve been here almost a month and trust me, this is a long overdue blog. it is my, you know you’re in tanzania when, blog. i'll add more when i have time... so here it goes:
you know you are in tanzania when:
-every price is negotiable and anything & everything is for sale.
-all locals stop what they’re doing when you walk down the street and the word “mzungu” follows you wherever you go. (I find this particularly odd because there are so many white people in arusha, im not exactly sure what the novelty is).
-grasshoppers are in your “sterile” operating room, always.
-a feeding tube can double as a foley catheter.
-milk tastes like it just came out of the cow… because it did.
-condoms and gloves make great bargaining tools.
-everything is fried in oil. everything.
-it is socially acceptable to answer your cell phone in any situation. cell phone etiquette does not exist and whether you’re in the middle of an important meeting, the doctor is rounding on your sick child, or you are doing a pelvic exam, if that phone rings you will let it play, (to enjoy your ring tone of course), and then answer it, no matter what, vaginal fluid on your glove and all.
-you feel a need to edit your will before crossing the street.
-being asian excludes you from having a US citizenship.
-a crosswalk is not a place to yield to pedestrians, it is a way of concentrating people so it’s easier to hit them – 5 points each?
-pens = extremely valuable and cherished.
-strangers will take your hand when you cross the street if you look particularly incompetent.
-food is served randomly, but consistently randomly, at restaurants. appetizers will come out last, main dishes will be brought to half the group and 20 minutes later the rest will get their food… customer service, what’s that?
-kids you just met think it is perfectly appropriate to take your hand as they walk down the street with you.
-everyone loves chelsea (the futbol team)
-you place your child on the laps of strangers when you’re on the dala dala
-carrying a purse around, carrying a live chicken around, both are equally socially acceptable.
That’s all for now but there’s much more to come!! t.i.a. :)
a few to add... you know you're in tanzania when:
-mosquito hunting is a sport. my tag line in arusha: fighting malaria, one mosquito at a time (that said, in the bush flies are much more of an issue, and quite a bit more difficult to kill. assuming my doxy works, I’d take a mosquito over a fly any day).
-you know to avoid bridges early in the morning, at dusk, any time it’s dark, and usually on sundays. you’re not exactly why but everyone has warned you about this and there are police at the bridges, so you don’t push your luck.
-you know several people, and they know several people, who have been robbed or mugged here in arusha (that’s comforting)
-it is not usually to see a truck with 20+ people standing in the back.
-men riding in the bed of a truck frequently wear hospital masks (if that’s any indication of the level of pollution here, just please take a deep breath of clean oregon air and appreciate it for me, because my lungs are dying here).
-no matter the day or time, there’s always a special price for you: special sunday price, special morning price, special rafiki price and on and on forever.
-you get called dada by the local women, and you’re no longer considering that they think you’re someone’s father, it means ‘sister’ in swahili.
-hand sanitizer and a little toilet paper accompany you everywhere you go.
-your boogers, you fear, are indefinitely brown.
-clothes need to be shaken very well before you bring them in from hanging dry. something about the detergent, just attracts the huge grasshoppers – awesome
-as a greeting, you bow your head to an elder so that they can touch it.
-you can do pretty much any activity to the light of a headlamp.
-the only two faces worth printing on khangas are obama’s and michael jackson’s.
-you do not find it unusual when two grown men walk down the street hand in hand. yes, we’d consider that a statement of homosexuality in the statues, here it is merely a sign of friendship.
-waving your arm around too close to the road can lead to a “freak accident” aka dr. ishmael breaking is arm on a car during his moring walk.
-there is a single porsche cayenne, red, and it goes 90+ mph no matter what road it’s on. see it and get far out of the way.
-you can fake your way through an entire swahili conversation using only three words: poa, sawa, and nzuri.
-everyone loves bob marley, and his music plays most everywhere you go. that or celine dion or michael jackson. they loovvvee sappy music here.
-you know to hold a rock in your hand when you’re let through the hostel gate late at night. the dogs are used to the guards chucking rocks at them, so if you want to be left alone, show those dogs the rock in your hand.
-a khanga has 731 different uses, probably twice that, but 731 is just the number of things I’ve actually seen it used for.
-everyone loves obama as much as you :)
-headwraps (which we think make us look like cancer patients) actually make for a great way to blend. Oddly enough you are 5 times less likely to be talked to when wearing a headwrap then when not…
-it is not unusual when driving to point out the window and exclaim “carcass” or “rib” or “skull” or some other type of animal remains.
-there’s no such thing as dark chocolate. terrib, I know.
-your taxi driver is most likely some local who got board and decided to make a few extra shillings driving mzungus around.
-it’s no problem is a phrase used regardless of the size of the problem.
Tuesday, July 20, 2010
Monday, July 19, 2010
same same but different
peds is peds here and then some...
pneumonia: lots of kids with respiratory issues, one, an eight year old, came in yesterday with pneumonia around noon and was dead by just after midnight – terribly sad. another newly admitted this morning with severe asthma. lots of coughing and congestion. on a good note, moses, the boy with the terrible chest xray who’s been here almost two weeks is finally improving with the combination of TB meds and antibiotics we’re giving him. his mother was complaining today that he cheeks looked swollen, the doc assured her it is simply that they’re filling in because he’s finally healthy again. it was pretty cute.
malnutrition: this one can be generalized to the maasai population though we see it in children from all over. but so many sick maasai babies, and their traditional medicine usually complicates the situation. the maasai baby I mentioned before, who was given lamande (a toxic herb used to help his diarrhea) passed away this weekend. very VERY frustrating because on friday when we rounded on him I had quite a conversation with dr. lace about what else we can do. he asked me what I wanted to do… of course I had no idea, we don’t have text books here to look things up, or internet, or experts of any sort, ugh! it just seemed like we were doing so little, or what we were doing was making the baby worse, and I wanted to bring in someone else to help him or take him to the OR or something! don’t just let him die alone without giving it everything we’ve got. unfortunately what we’ve got here is very limited and when we came in this morning I looked to the bed where he usually lays and there was an unfamiliar face, I was right to assume the worst, at least he’s not suffering anymore. so young… and disturbingly preventable. I just hope that mother goes back and shares the story with the others so that maybe lamande won’t be given to the next baby with diarrhea. our big malnutrition case today was frankie, a 7 year old boy weighing 14 kilos. along with malnutrition comes periorbital swelling (from protein deficiency) and usually severe anemia, both of which frankie had. we deworm these kids as a precaution, transfuse if their Hb is less than 5, and start them on the F-75 nutrition formula. frankie was getting the full treatment and then some. he was sent to the malnutrition ward. it is devastating to see the cases there, I don’t like when we round on those kids because it is so difficult to see... it makes you feel guilty for all you have, the nice meals you eat, parents who could care for you so well when you were growing up. there’s a lot to make most anyone feel a bit of guilt…
gastroenteritis: lots of vomiting and diarrhea. in these cases dehydration is a big issue. watched a little boy just vomit over the side of the bed this morning. mom cleaned it up with a khanga… those things have more uses here….
the mystery case: boy, age 9, comes in and dr. lace leaves rounds to see him, calls us over and at first all I see is a fidgety little kid. but a few seconds of watching him and I realize he’s actually having uncontrolled muscle movement sporadically across his entire body. how bizarre. apparently it started two months ago and has been getting progressively worse to the point where he can no longer talk and is having trouble feeding. I couldn’t take my eyes off of it. acute onset choriathatosis (im sure that is not how you spell it but google isn’t working here so I can’t look it up. actually, if anyone is able to research it at all it would be greatly helpful. we’re trying to figure out the cause but there seem to be a lot of things here that can cause neurological symptoms like this) and he’s degenerating. he could walk. we took a video. discussed some ddx. wild. I have never seen anything like it. he looked like a 9 year old parkinson’s or huntington’s patient. the doc is going to research it tonight, get a second opinion from another pediatrician. I wish we had a neurologist who could come take a look at him. we did a mini neuro exam and he did alright. it’d be nice to get a CT to see what’s going on in his brain but the chance of that happening is slim. anyway, ill keep you posted on this interesting case.
pneumonia: lots of kids with respiratory issues, one, an eight year old, came in yesterday with pneumonia around noon and was dead by just after midnight – terribly sad. another newly admitted this morning with severe asthma. lots of coughing and congestion. on a good note, moses, the boy with the terrible chest xray who’s been here almost two weeks is finally improving with the combination of TB meds and antibiotics we’re giving him. his mother was complaining today that he cheeks looked swollen, the doc assured her it is simply that they’re filling in because he’s finally healthy again. it was pretty cute.
malnutrition: this one can be generalized to the maasai population though we see it in children from all over. but so many sick maasai babies, and their traditional medicine usually complicates the situation. the maasai baby I mentioned before, who was given lamande (a toxic herb used to help his diarrhea) passed away this weekend. very VERY frustrating because on friday when we rounded on him I had quite a conversation with dr. lace about what else we can do. he asked me what I wanted to do… of course I had no idea, we don’t have text books here to look things up, or internet, or experts of any sort, ugh! it just seemed like we were doing so little, or what we were doing was making the baby worse, and I wanted to bring in someone else to help him or take him to the OR or something! don’t just let him die alone without giving it everything we’ve got. unfortunately what we’ve got here is very limited and when we came in this morning I looked to the bed where he usually lays and there was an unfamiliar face, I was right to assume the worst, at least he’s not suffering anymore. so young… and disturbingly preventable. I just hope that mother goes back and shares the story with the others so that maybe lamande won’t be given to the next baby with diarrhea. our big malnutrition case today was frankie, a 7 year old boy weighing 14 kilos. along with malnutrition comes periorbital swelling (from protein deficiency) and usually severe anemia, both of which frankie had. we deworm these kids as a precaution, transfuse if their Hb is less than 5, and start them on the F-75 nutrition formula. frankie was getting the full treatment and then some. he was sent to the malnutrition ward. it is devastating to see the cases there, I don’t like when we round on those kids because it is so difficult to see... it makes you feel guilty for all you have, the nice meals you eat, parents who could care for you so well when you were growing up. there’s a lot to make most anyone feel a bit of guilt…
gastroenteritis: lots of vomiting and diarrhea. in these cases dehydration is a big issue. watched a little boy just vomit over the side of the bed this morning. mom cleaned it up with a khanga… those things have more uses here….
the mystery case: boy, age 9, comes in and dr. lace leaves rounds to see him, calls us over and at first all I see is a fidgety little kid. but a few seconds of watching him and I realize he’s actually having uncontrolled muscle movement sporadically across his entire body. how bizarre. apparently it started two months ago and has been getting progressively worse to the point where he can no longer talk and is having trouble feeding. I couldn’t take my eyes off of it. acute onset choriathatosis (im sure that is not how you spell it but google isn’t working here so I can’t look it up. actually, if anyone is able to research it at all it would be greatly helpful. we’re trying to figure out the cause but there seem to be a lot of things here that can cause neurological symptoms like this) and he’s degenerating. he could walk. we took a video. discussed some ddx. wild. I have never seen anything like it. he looked like a 9 year old parkinson’s or huntington’s patient. the doc is going to research it tonight, get a second opinion from another pediatrician. I wish we had a neurologist who could come take a look at him. we did a mini neuro exam and he did alright. it’d be nice to get a CT to see what’s going on in his brain but the chance of that happening is slim. anyway, ill keep you posted on this interesting case.
the elusive dung beetle
another day, another adventure. our plan was simply this: arusha national park for the day. we’ve been here three plus weeks and, aside from the occasional monkey, have yet to see cool animals. we needed some safari animals in our lives so we set out to find them. three dala dala rides and 1,500 tzs later we were waiting a few kilometers from the park gate as the driver of our third dala dala attempted to fix the broken tire. your odds here are about one in three dala dalas will break down and/or crash, so taking three dala dalas in one day pretty much guaranteed us some mechanical issues.
we make it to the park gate where a handful of armed guards are standing, taking papers from safari vehicles then raising the gate so they can pass. we climb out of our dala dala and notice a mzungu staring into the bush. I immediately follow his gaze and do not believe my eyes. there, his huge head over the tops of the bushes, is a massive giraffe, and he’s extremely close. it was pretty much the coolest thing I’ve ever seen (note: I say this about most things I see that I find cool)… I stand on one of the parking posts to get a better look and realize that this giraffe is not alone, there are probably a dozen others of varying heights just feeding in the area near the small gravel parking lot. there were few people around and when the guy who had first seen the giraffes took off on the small trail leading between the bushes you can bet I followed. we emerged into a small opening and stood at the feet of these beautiful animals. a few of the ones near by startled a little and the sound of their massive hooves as they galloped to distance themselves from us was booming. (kelli, you should be soooo excited, get ready to decorate your room with giraffe pics galore!) I probably took about 50 shots of these incredible giants feeding there so close to me. right then and there my day was pretty much complete, but we decided we’d come this far and should try to see more animals. also, I was pretty hung up on seeing a dung beetle, so that was reason enough to pay to enter the park :)
we went to pay our park admission, $35 usd, and also the $20 per client fee to have a walking guided tour (apparently you need a guy with a gun to lead you around). unfortunately, no one had informed us that you cannot do walking tours from the ngongongare gate so we’re standing at that gate with no idea what to do. take the dala dala that’s already gone back down to where we started and take another to the other main gate of the park? no thanks. we are debating our options when this local comes up to us and says he’ll take us to the other gate for free. now, if there’s one thing I’ve learned in arusha, it’s that nothing is free (except the garlic bread at blue heron of course). is this guy trying to get us to tour with him so he can charge us later? maybe. is he going to steal us and sell us into the sex trade? most likely. so what do we do? we climb in his car!! duh. sorry mom :) but fear not, this was far from a lapse in judgment…
before getting in the car we were definitely thinking, ‘there has to be a catch’ as we run worse case scenarios through our heads. but it doesn’t take us long to figure out that this guy, frederick, overheard us just get jected by the park and, by a good stroke of luck for us, he has come to the park with his mother on this day to see the animals and is offering for us to go along with them. he’s dressed all suave in some nice denim and a brown vest over a white dress shirt. how convenient that he has his non-threatening mother along and that they have three empty seats in the back of their suzuki. sounds like a pretty good start to some traveler horror film, am I right? or at least, this is wayyy too good to be true… we’re thinking the same thing as we wait to enter the park, having only paid our individual entry fees (he didn’t even ask us to pitch in to help pay the car entry fee). we hand over our papers to the gate to prove we’ve been admitted and we’re so close to entering, I can practically smell the animals!! and then, and then… he’s turning the car around…? we have to what? go get batteries for their camera? Riiiiggghhhttttt… is what I’m thinking at this point, this is the part where he drives us to some brothel and gets us hooked on drugs… you’ve all seen the movie Taken, you get the idea. we ask him if we can get out and photograph the giraffes while they run to get a battery, who knows how long that’ll take, or if they’ll ever come back. he’s cool with it and lets us out. we’re watching as the car drives away, our hopes of a day in the park are disintegrating before our eyes. we go to take more photos of the giraffes, debating our next move… but then, not three minutes and a dozen giraffe photos later, that suzuki is back and frederick is calling us over. is this f’real?! we climb back in the car, they had no luck finding batters, would we be able to email them the photos we take? of course! hakuna matata rafiki!! and believe it or not we are through that gate and the adventure begins. luck luck luck.
zebras, giraffes, water buffalo, oh my! yes, we were seeing the african clichés immediately upon entering and it was awesome. frederick served as a tour guide for the four of us, the three mzungus and mama. he would cruise down the dirt roads, through forests and past fields with more zebras and pumbas and gazelle with crazy horns. we’d stop every now and again to photograph the animals, get out at the designated places to see little momella lake, then big momella lake. we cruised around that park for a good four hours, better than any safari we could have paid for. it’s funny because the park is such a maze and you totally get trapped inside, forced to tour all of the roads and destinations, which was fine by us, I was having the time of my life! we’d turn a corner and there in the distance you’d see a huge giraffe, his head sticking up over the trees. round bird nests hung in the thorned trees beside the road (thought despite hunting high and low for a sausage tree we never found one). birds with poofs of feathers atop their heads. any time we used swahili words it cracked frederick and mama up, people here love it when you can speak the language, and with a handful of words and phrases you can convince pretty much any local that you’re fluent (they definitely give you the benefit of the doubt). mama wanted to have her picture taken in the forest, but she didn’t want to get out because of the “dangerous animals”. their english was great and it was really cute to hear them talk back and fourth, she kept telling him polle polle which means slowly.
we drove up on a family of monkeys… they looked like baboons to me but I’m not sure. they were in the road and had no fear of the car. they walked casually along the road in front of the car, the babies clinging to the backs of the mothers. freddy started singing ludacris “move, get out the way” song and we all died laughing. or maybe he sang that when we encountered more massive giraffes that refused to move out from in front of the car. they just stood there, not 10 feet from the bumper, analyzing the little suzuki. also, probably the most unusual and unexpected animal sighting was the lake of flamingos. who knew that flamingos live in tanzania?! and I’m not just talking a couple. I’m talking this lake was pink around the edges with the birds packed together!! it was wild. we also had a tsetse fly come in the window, mama identified it, and as they were trying to shoe it out of the car it literally landed between freddy’s eyes, on the bridge of his nose! it was a creepy looking fly and I was happy to leave it behind with our dust. so much dust! but I wanted my window down so I could see everything clearly and with my head hanging practically half out the window, by the time I got home and removed my sunglasses you could actually see the dust line caked on my face around where my sunglasses had been. don’t worry, I have photo evidence. more zebras and giraffes and lakes of flamingos later we were finally headed home. and get this, freddy and mama were headed back to arusha so they dropped us at our dala dala stop on their way. that’s right. and we offered to pay them, to help with gas or whatever, and they refused. it was a full day tour of arusha national park that cost us only the entrance fee, and we got out of the car thanking them and promising to post pictures, feeling like we were possibly the luckiest three travelers in arusha. my only complaint was that we didn’t see a dung beetle, I was pretty hung up on that, but there’s always our next safari.
some of local kids joined us for our walk back to the hostel. one of the little boys just walks up to me and takes my hand and starts speaking to me in english and we walked hand in hand back to the hostel at which point they split off to go play futbol. we chatted the whole way, his english very impressive, my swahili pretty spotty, but the combo makes for a smooth, and very entertaining, conversation. he told me chelsea was his favorite futbol team, and he plays goalie here. the kids here are adorable and it cracks me up that they’re comfortable just coming up and taking your hand and walking with you. I love it!
back at the hostel and still in a bit of shock about our good fortune for the day, we quickly realized there was a party going on out back, a wedding to be precise. and it was in full swing. singing and dancing and lots of eating and drinking and music, these people know how to party. even with the electricity out for the day (and we would soon find, most of the night as well) they had a generator they were using to play music and had cooked the massive amounts of rice and strange plantine banana-type things with the gas stove. vene came up to invite us to celebrate with them. I threw on a skirt and headed down to the party. samuel made me try this disgusting banana beer they make. it’s all chunky and bitter and he was drinking it out of this massive glass and he kept making me take sips so people could laugh at my face, they were extremely entertained, it was foul, but I humored them. got some food and enjoyed the wedding traditions, which include the women each taking one of the wedding gifts and dancing around and circling the bride and groom with the gifts and setting them at their feet. then they do this all over again with khangas and khatangas and things for the kitchen and so on… it’s quite the procession. lots of hooting and hollering and singing and crazy dancing that went well on into dusk, at which point the mosquitoes were out and we retreated to our dark room.
it was hanging out adorned with headlamps for the rest of the night. we’ve met some new friends who are living next door and they are in the stanford graduate engineering program right now. the girl did her undergrad at stanford as well and knows one of our classmates. the two guys I was discussing bay to breakers with (a costumed race in SF) and realized I saw their costumes and in fact could pull up photos on my camera of them during the race. how’s that for small world?! we couldn’t believe it! then again, being a potato peeler is a pretty distinctive costume. we got a real kick out of the fact that I actually had photos of them on my camera. the three of them are all in their late 20’s and working on a project involving solar fridges, it sounds really cool, and is kinda top secret, so no telling anyone :) hostels are the BEST best place to make new friends, and tanzania in general is a great place to make new friends but I’m glad my facebook profile can’t be searched because everyone here wants to find you on facebook or get your cell number (which we don’t mind giving out so much b/c they’re local phones here… except that amy lost her cell last night and the one thu brought never worked so now we’re just down to mine).. last event of the night, sister rose had to come hush us around 10pm because with 8 of us in our tiny room we were being wayyy too noisy. I’ve not been scolded by a sister before but it can’t be a good thing. we must’ve polle sana-ed (sorry a lot) her 30 times in the 5 seconds she was in our room asking us to keep it down. oops. sorry centre house!
the inspirational quote for the day comes from one of the taxi drivers here. he was driving us to massai camp last night, it’s a local bar and fun hangout… we were laughing pretty uncontrollably in the car as we rattled off pretty much every swahili word we knew between the four of us in an attempt to carry on a conversation with the local and our driver stops and says “laughing much makes the years of living greater” and then he pauses and enlightens us further “and everyone wants to extend the years of living”. words to live by.
we make it to the park gate where a handful of armed guards are standing, taking papers from safari vehicles then raising the gate so they can pass. we climb out of our dala dala and notice a mzungu staring into the bush. I immediately follow his gaze and do not believe my eyes. there, his huge head over the tops of the bushes, is a massive giraffe, and he’s extremely close. it was pretty much the coolest thing I’ve ever seen (note: I say this about most things I see that I find cool)… I stand on one of the parking posts to get a better look and realize that this giraffe is not alone, there are probably a dozen others of varying heights just feeding in the area near the small gravel parking lot. there were few people around and when the guy who had first seen the giraffes took off on the small trail leading between the bushes you can bet I followed. we emerged into a small opening and stood at the feet of these beautiful animals. a few of the ones near by startled a little and the sound of their massive hooves as they galloped to distance themselves from us was booming. (kelli, you should be soooo excited, get ready to decorate your room with giraffe pics galore!) I probably took about 50 shots of these incredible giants feeding there so close to me. right then and there my day was pretty much complete, but we decided we’d come this far and should try to see more animals. also, I was pretty hung up on seeing a dung beetle, so that was reason enough to pay to enter the park :)
we went to pay our park admission, $35 usd, and also the $20 per client fee to have a walking guided tour (apparently you need a guy with a gun to lead you around). unfortunately, no one had informed us that you cannot do walking tours from the ngongongare gate so we’re standing at that gate with no idea what to do. take the dala dala that’s already gone back down to where we started and take another to the other main gate of the park? no thanks. we are debating our options when this local comes up to us and says he’ll take us to the other gate for free. now, if there’s one thing I’ve learned in arusha, it’s that nothing is free (except the garlic bread at blue heron of course). is this guy trying to get us to tour with him so he can charge us later? maybe. is he going to steal us and sell us into the sex trade? most likely. so what do we do? we climb in his car!! duh. sorry mom :) but fear not, this was far from a lapse in judgment…
before getting in the car we were definitely thinking, ‘there has to be a catch’ as we run worse case scenarios through our heads. but it doesn’t take us long to figure out that this guy, frederick, overheard us just get jected by the park and, by a good stroke of luck for us, he has come to the park with his mother on this day to see the animals and is offering for us to go along with them. he’s dressed all suave in some nice denim and a brown vest over a white dress shirt. how convenient that he has his non-threatening mother along and that they have three empty seats in the back of their suzuki. sounds like a pretty good start to some traveler horror film, am I right? or at least, this is wayyy too good to be true… we’re thinking the same thing as we wait to enter the park, having only paid our individual entry fees (he didn’t even ask us to pitch in to help pay the car entry fee). we hand over our papers to the gate to prove we’ve been admitted and we’re so close to entering, I can practically smell the animals!! and then, and then… he’s turning the car around…? we have to what? go get batteries for their camera? Riiiiggghhhttttt… is what I’m thinking at this point, this is the part where he drives us to some brothel and gets us hooked on drugs… you’ve all seen the movie Taken, you get the idea. we ask him if we can get out and photograph the giraffes while they run to get a battery, who knows how long that’ll take, or if they’ll ever come back. he’s cool with it and lets us out. we’re watching as the car drives away, our hopes of a day in the park are disintegrating before our eyes. we go to take more photos of the giraffes, debating our next move… but then, not three minutes and a dozen giraffe photos later, that suzuki is back and frederick is calling us over. is this f’real?! we climb back in the car, they had no luck finding batters, would we be able to email them the photos we take? of course! hakuna matata rafiki!! and believe it or not we are through that gate and the adventure begins. luck luck luck.
zebras, giraffes, water buffalo, oh my! yes, we were seeing the african clichés immediately upon entering and it was awesome. frederick served as a tour guide for the four of us, the three mzungus and mama. he would cruise down the dirt roads, through forests and past fields with more zebras and pumbas and gazelle with crazy horns. we’d stop every now and again to photograph the animals, get out at the designated places to see little momella lake, then big momella lake. we cruised around that park for a good four hours, better than any safari we could have paid for. it’s funny because the park is such a maze and you totally get trapped inside, forced to tour all of the roads and destinations, which was fine by us, I was having the time of my life! we’d turn a corner and there in the distance you’d see a huge giraffe, his head sticking up over the trees. round bird nests hung in the thorned trees beside the road (thought despite hunting high and low for a sausage tree we never found one). birds with poofs of feathers atop their heads. any time we used swahili words it cracked frederick and mama up, people here love it when you can speak the language, and with a handful of words and phrases you can convince pretty much any local that you’re fluent (they definitely give you the benefit of the doubt). mama wanted to have her picture taken in the forest, but she didn’t want to get out because of the “dangerous animals”. their english was great and it was really cute to hear them talk back and fourth, she kept telling him polle polle which means slowly.
we drove up on a family of monkeys… they looked like baboons to me but I’m not sure. they were in the road and had no fear of the car. they walked casually along the road in front of the car, the babies clinging to the backs of the mothers. freddy started singing ludacris “move, get out the way” song and we all died laughing. or maybe he sang that when we encountered more massive giraffes that refused to move out from in front of the car. they just stood there, not 10 feet from the bumper, analyzing the little suzuki. also, probably the most unusual and unexpected animal sighting was the lake of flamingos. who knew that flamingos live in tanzania?! and I’m not just talking a couple. I’m talking this lake was pink around the edges with the birds packed together!! it was wild. we also had a tsetse fly come in the window, mama identified it, and as they were trying to shoe it out of the car it literally landed between freddy’s eyes, on the bridge of his nose! it was a creepy looking fly and I was happy to leave it behind with our dust. so much dust! but I wanted my window down so I could see everything clearly and with my head hanging practically half out the window, by the time I got home and removed my sunglasses you could actually see the dust line caked on my face around where my sunglasses had been. don’t worry, I have photo evidence. more zebras and giraffes and lakes of flamingos later we were finally headed home. and get this, freddy and mama were headed back to arusha so they dropped us at our dala dala stop on their way. that’s right. and we offered to pay them, to help with gas or whatever, and they refused. it was a full day tour of arusha national park that cost us only the entrance fee, and we got out of the car thanking them and promising to post pictures, feeling like we were possibly the luckiest three travelers in arusha. my only complaint was that we didn’t see a dung beetle, I was pretty hung up on that, but there’s always our next safari.
some of local kids joined us for our walk back to the hostel. one of the little boys just walks up to me and takes my hand and starts speaking to me in english and we walked hand in hand back to the hostel at which point they split off to go play futbol. we chatted the whole way, his english very impressive, my swahili pretty spotty, but the combo makes for a smooth, and very entertaining, conversation. he told me chelsea was his favorite futbol team, and he plays goalie here. the kids here are adorable and it cracks me up that they’re comfortable just coming up and taking your hand and walking with you. I love it!
back at the hostel and still in a bit of shock about our good fortune for the day, we quickly realized there was a party going on out back, a wedding to be precise. and it was in full swing. singing and dancing and lots of eating and drinking and music, these people know how to party. even with the electricity out for the day (and we would soon find, most of the night as well) they had a generator they were using to play music and had cooked the massive amounts of rice and strange plantine banana-type things with the gas stove. vene came up to invite us to celebrate with them. I threw on a skirt and headed down to the party. samuel made me try this disgusting banana beer they make. it’s all chunky and bitter and he was drinking it out of this massive glass and he kept making me take sips so people could laugh at my face, they were extremely entertained, it was foul, but I humored them. got some food and enjoyed the wedding traditions, which include the women each taking one of the wedding gifts and dancing around and circling the bride and groom with the gifts and setting them at their feet. then they do this all over again with khangas and khatangas and things for the kitchen and so on… it’s quite the procession. lots of hooting and hollering and singing and crazy dancing that went well on into dusk, at which point the mosquitoes were out and we retreated to our dark room.
it was hanging out adorned with headlamps for the rest of the night. we’ve met some new friends who are living next door and they are in the stanford graduate engineering program right now. the girl did her undergrad at stanford as well and knows one of our classmates. the two guys I was discussing bay to breakers with (a costumed race in SF) and realized I saw their costumes and in fact could pull up photos on my camera of them during the race. how’s that for small world?! we couldn’t believe it! then again, being a potato peeler is a pretty distinctive costume. we got a real kick out of the fact that I actually had photos of them on my camera. the three of them are all in their late 20’s and working on a project involving solar fridges, it sounds really cool, and is kinda top secret, so no telling anyone :) hostels are the BEST best place to make new friends, and tanzania in general is a great place to make new friends but I’m glad my facebook profile can’t be searched because everyone here wants to find you on facebook or get your cell number (which we don’t mind giving out so much b/c they’re local phones here… except that amy lost her cell last night and the one thu brought never worked so now we’re just down to mine).. last event of the night, sister rose had to come hush us around 10pm because with 8 of us in our tiny room we were being wayyy too noisy. I’ve not been scolded by a sister before but it can’t be a good thing. we must’ve polle sana-ed (sorry a lot) her 30 times in the 5 seconds she was in our room asking us to keep it down. oops. sorry centre house!
the inspirational quote for the day comes from one of the taxi drivers here. he was driving us to massai camp last night, it’s a local bar and fun hangout… we were laughing pretty uncontrollably in the car as we rattled off pretty much every swahili word we knew between the four of us in an attempt to carry on a conversation with the local and our driver stops and says “laughing much makes the years of living greater” and then he pauses and enlightens us further “and everyone wants to extend the years of living”. words to live by.
Friday, July 16, 2010
me need bigger hammer
inspirational quote for the day, you ready for this? I read this every morning on the hot water jug they put out for tea. It is baby pink and has a hideous flower design on it. in small print at the bottom it says: “there are no springs without flowers, there are not gains without pains” – inspirational, right? yeah, they know how to start the morning off right here :)
today we left for the hospital tres excited because we had seen many a sweet case in need of operations yesterday, and today the OR schedule was packed!! thu and I raced to change for OR time while amy went to peds, intent on meeting up with us later. we dropped off some supplies with the OR nurses and got the same excessive gratitude we always get. It doesn’t matter if we’re giving gloves or masks or scalpels, you’d think we’re saints brining in these supplies, and we usually get blessed by the staff in one way or another. So all of you out there who donated to this trip, thank you, because your donations are making a big difference to the people here, the hospital staff and patients alike.
we were in the major theater with dr. lee today (minor theater was mostly for more casting). we were scrubbed and ready before all of the docs so we chatted with the engineers a while. not sure if I’ve mentioned them yet but we met them during our second week, two boys part way through their undergrad who have come here to fix pretty much anything and everything. no joke, they’ve fixed everything from cribs in the nicu to the xray machine. pretty handy guys I guess, the great news is they just got the bovi working! very exciting to have a tool that actually cauterizes arteries rather than having to tie each bleeding artery off individually (unfortunately the voltage is still a little off so it didn’t perform as well as we were hoping during the surgeries today).
the first patient was a young boy we had seen yesterday. the lateral condyle of his humerous is protruding, not through the skin, but it’s an obvious break that had caused a fixed bend in his elbow that will lead to serious problems as he grows, so dr. lee is doing external fixation today to try to repair it. the surgery is so interesting, partly because I love the skeletal system, but also because of the way they do things here. surgeons back home would cringe at the disorganization. surgical instruments sprawled across the “sterile” field, nothing that dr. lee needs and a lot of stuff just getting in the way. the lighting is terrible, I suppose we’re lucky to have electricity on this day and shouldn’t complain. dr. lee has taped the boy’s xray to the window across from where he works, to reference during the surgery. all goes well, aside from the attempt to knock the poor kid out for the surgery. they try to intubate, but the boy is awake enough to cough out the tube, not good. they give him more drugs, he’s on a ventilator but breathing on his own so it’s not on. the “anesthesiologist” is manually bagging periodically but I can’t help thinking this kid is not getting enough oxygen to his brain, and the brain does not tolerate hypoxia well. As the surgery begins the child stirs… more than stirs, he’s awake… is he crying? we’re all looking around, wondering what the plan is, will someone please knock this kid out?! finally they get it under control. part of the problem is that they have to make a decision when they’re putting a patient under, they don’t have the machines to properly monitor the patient so they must carefully find the correct balance between pain, and a patient that won’t wake up at the end of the procedure. it is a fine line and they tend to err on the side of pain, because the other way you have a drug overdose that leads to death. they finish the surgery, wake him up… sort of, he struggles to breath for a while but should be fine. it is all a bit stressful, more stressful than the ORs back home because if something goes wrong we do not have the same resources to fix the problem.
next cool surgery, motor vehicle crash… this one might have been a motorbike, or peds vs auto, either way, no good for the patient. The head of his femur is posteriorly dislocated and the acetabulum itself is fractured, along with the anterior part of the pelvis. that is bad in and of itself, but on top of that he has a severe ankle injury and a break straight through his femur. it’s actually quite beautiful, very straight and clean and I cannot even imagine the sound it must’ve made when it broke because this guy is young and fit and very tall. “that is a big femur” said one of the nurses who walked in the room mid-surgery. dr. lee is awesome. Makes the incision, finds the facial plane, dissects down looking for a plane between two muscles where he can find the fractured ends of the bone. they use a rod, driveit down the shaft of the femur to hold the two ends together. the surgery is long but time flies by, this operating theater is big and we have freedom to move around and watch from different angles. The patient is awake. Oh, did I fail to mention that earlier? Yes, this patient is awake, just numb from the waist down. He can feel his entire body jerk around as they manipulate the bone, trying to get it back into alignment. He can hear and feel the bang of the hammer against the metal rod they’re driving down his bone. he knows daaimah (who has joined us in the OR today to observe as a favor from dr. lee) is taking pictures and he keeps asking her if he can see them. We advise her to wait until after the surgery is over. It is amazing to me that a gumby leg, the thigh bending unnaturally as if there is no bone inside at all, can be fixed and looking almost good as new after a few hours in the OR. that is the magic or surgery :)
nothing works up an appetite like a few hours in the OR, and we had our best meal yet today, post-surgery… except that I think I’ve said that before, but it’s ok to think every meal is your best meal so whatevs :) we ate at a place called milk and honey. it’s a local spot that also caters to travelers, which is nice. I went with vegetable curry with chipati and I was so content by the end of that meal. I’m gonna miss chipati when I get home, I can already tell. It’s like the roti of Tanzania (yes lo, you heard me, you would love it!) and I think they need to start making dessert chipati with butter and cinnamon sugar like tanzania’s version of the elephant ear. I think I’ll tell a local this idea, get it started, and they’ll have the most popular chiapti stand in town. where’s rogers when you need him? he’d be all for it :)
today we left for the hospital tres excited because we had seen many a sweet case in need of operations yesterday, and today the OR schedule was packed!! thu and I raced to change for OR time while amy went to peds, intent on meeting up with us later. we dropped off some supplies with the OR nurses and got the same excessive gratitude we always get. It doesn’t matter if we’re giving gloves or masks or scalpels, you’d think we’re saints brining in these supplies, and we usually get blessed by the staff in one way or another. So all of you out there who donated to this trip, thank you, because your donations are making a big difference to the people here, the hospital staff and patients alike.
we were in the major theater with dr. lee today (minor theater was mostly for more casting). we were scrubbed and ready before all of the docs so we chatted with the engineers a while. not sure if I’ve mentioned them yet but we met them during our second week, two boys part way through their undergrad who have come here to fix pretty much anything and everything. no joke, they’ve fixed everything from cribs in the nicu to the xray machine. pretty handy guys I guess, the great news is they just got the bovi working! very exciting to have a tool that actually cauterizes arteries rather than having to tie each bleeding artery off individually (unfortunately the voltage is still a little off so it didn’t perform as well as we were hoping during the surgeries today).
the first patient was a young boy we had seen yesterday. the lateral condyle of his humerous is protruding, not through the skin, but it’s an obvious break that had caused a fixed bend in his elbow that will lead to serious problems as he grows, so dr. lee is doing external fixation today to try to repair it. the surgery is so interesting, partly because I love the skeletal system, but also because of the way they do things here. surgeons back home would cringe at the disorganization. surgical instruments sprawled across the “sterile” field, nothing that dr. lee needs and a lot of stuff just getting in the way. the lighting is terrible, I suppose we’re lucky to have electricity on this day and shouldn’t complain. dr. lee has taped the boy’s xray to the window across from where he works, to reference during the surgery. all goes well, aside from the attempt to knock the poor kid out for the surgery. they try to intubate, but the boy is awake enough to cough out the tube, not good. they give him more drugs, he’s on a ventilator but breathing on his own so it’s not on. the “anesthesiologist” is manually bagging periodically but I can’t help thinking this kid is not getting enough oxygen to his brain, and the brain does not tolerate hypoxia well. As the surgery begins the child stirs… more than stirs, he’s awake… is he crying? we’re all looking around, wondering what the plan is, will someone please knock this kid out?! finally they get it under control. part of the problem is that they have to make a decision when they’re putting a patient under, they don’t have the machines to properly monitor the patient so they must carefully find the correct balance between pain, and a patient that won’t wake up at the end of the procedure. it is a fine line and they tend to err on the side of pain, because the other way you have a drug overdose that leads to death. they finish the surgery, wake him up… sort of, he struggles to breath for a while but should be fine. it is all a bit stressful, more stressful than the ORs back home because if something goes wrong we do not have the same resources to fix the problem.
next cool surgery, motor vehicle crash… this one might have been a motorbike, or peds vs auto, either way, no good for the patient. The head of his femur is posteriorly dislocated and the acetabulum itself is fractured, along with the anterior part of the pelvis. that is bad in and of itself, but on top of that he has a severe ankle injury and a break straight through his femur. it’s actually quite beautiful, very straight and clean and I cannot even imagine the sound it must’ve made when it broke because this guy is young and fit and very tall. “that is a big femur” said one of the nurses who walked in the room mid-surgery. dr. lee is awesome. Makes the incision, finds the facial plane, dissects down looking for a plane between two muscles where he can find the fractured ends of the bone. they use a rod, driveit down the shaft of the femur to hold the two ends together. the surgery is long but time flies by, this operating theater is big and we have freedom to move around and watch from different angles. The patient is awake. Oh, did I fail to mention that earlier? Yes, this patient is awake, just numb from the waist down. He can feel his entire body jerk around as they manipulate the bone, trying to get it back into alignment. He can hear and feel the bang of the hammer against the metal rod they’re driving down his bone. he knows daaimah (who has joined us in the OR today to observe as a favor from dr. lee) is taking pictures and he keeps asking her if he can see them. We advise her to wait until after the surgery is over. It is amazing to me that a gumby leg, the thigh bending unnaturally as if there is no bone inside at all, can be fixed and looking almost good as new after a few hours in the OR. that is the magic or surgery :)
nothing works up an appetite like a few hours in the OR, and we had our best meal yet today, post-surgery… except that I think I’ve said that before, but it’s ok to think every meal is your best meal so whatevs :) we ate at a place called milk and honey. it’s a local spot that also caters to travelers, which is nice. I went with vegetable curry with chipati and I was so content by the end of that meal. I’m gonna miss chipati when I get home, I can already tell. It’s like the roti of Tanzania (yes lo, you heard me, you would love it!) and I think they need to start making dessert chipati with butter and cinnamon sugar like tanzania’s version of the elephant ear. I think I’ll tell a local this idea, get it started, and they’ll have the most popular chiapti stand in town. where’s rogers when you need him? he’d be all for it :)
m&ms for abscess drainage
a hospital can be a happy place. a place where you are able to make people better, healthier, keep them alive, fix them when they are broken… it can also be a sad place, a reminder of all of the accidents and crimes and bad things out there that can hurt people, make them sick, and end lives. yesterday was more of the latter, and those days are tough…
surgery rounds were yesterday, sad, but very interesting. part of what made it interesting was, obviously, the patients we saw, but also, on this particular day they were painting the hospital. unlike in the U.S. they do not close the wing to paint, instead they paint around the patients and doctors and nurses, so as we did rounds people kept bumping into walls and doors with wet paint. the docs are examining patients with painted hands and the nurses have paint in their hair and the med students are getting it on their white coats. were the smell a little less toxic, the whole thing would have been quite comical.
a few of the more interesting surgical cases: a patient, who I noticed when they uncovered him, had wet himself. this was a full grown adult so I found that strange. turns out he’s a spinal, no feeling in his legs up to his abdomen. really tragic to see in someone that young. he looked absolutely terrified, and rightfully so. I’m not sure what they can do for him here… probably couldn’t do much more for a similar patient back home. it is patients like this that make me take a step back and appreciate my good health. we should all take a moment, far more often than we do, to appreciate how fortunate we are.
a young kid, another motor vehicle crash, who was very out of it. thu and I wanted to perform a neuro exam on him, until we realized our swahili isn’t nearly proficient enough for that. I checked his pupillary reflex and his left pupil was totally unresponsive. first time I’ve seen that.
we visited the burn unit as well. probably the most traumatizing experience I’ve had since being here. in my opinion, burns are one of the worst injuries you can sustain. so painful and completely devastating, especially when they cover large areas of the body as we saw with most of these patients. they have wire ‘tents’ on the beds, covered in blankets, to keep the patients warm without touching the raw burns. they basically try to keep the skinless areas clean and cover them in vaseline in an attempt to prevent too much water loss. frequently children, usually burned from hot oil or water because so many the people here live in tiny huts where kitchens and beds are side by side - it is all too common to see severe burns. arms, torsos, and legs, all covered in deep burns. really awful to see, and so much suffering. the worst was (warning, you might just want to skip to the next paragraph) a young girl, maybe about 1 year old, who had burns all over her face and head. when we went through our section this year on child abuse, one of the things we were taught to look for when a child comes in with burns is patterns and submersion burns (with a neat line where you can see the hand or foot was held under the boiling water). this child had a neat line all the way around her neck. the only way I can figure a child would get a burn like that would be if she was literally dangled by her feet and her head was dunked in boiling water. it is seriously too awful to think about, but something we must consider. I had dr. lee ask the mother about the burn, she said the child fell in hot oil. the problem is, there’s not exactly a social services worker here we can call. furthermore, im sure it is not the mother, sitting patiently with the child and comforting her, who is responsible, but the male of the household, whoever that might be. sadly, these cases are not unique to developing countries, they happen in the U.S. too and it is heartbreaking.
after surgery rounds, which took us through four wards and past countless terrible breaks from motor vehicle accidents, I went downstairs to catch up on peds. lost a kid last night, so that’s always hard, and you can’t help but wonder if the outcome would have been the same in a better facility. all you can do is evaluate the death, make sure no mistakes were made, and move on. apparently dr. james says they usually lose about a kid a night here. that was staggering to hear but some of the kids do come in really sick. we had a new admin there, a young child who had aspirated kerosene. that was interesting. there was a 2 year old maasai baby who weighed only 9 kilos. and another massai baby with a Hb of 1.4, low enough to warrant a blood transfusion, something you rarely see here. the family must be willing to donate in this case, blood is so scarce. we have several cases of ventricular septal defects, a heart defect, with the peds patients right now. great practice for listening to mururs but sad because there’s not much we can do for them here. we also saw our little boy with an abscess on his chin that was huge the first time we drained it, probably 40ml of puss came out. we drained it again today, so disgusting, but oddly satisfying. poor kid is never going to go to a doc again in his life, it is traumatizing, and very painful to have an abscess drained. we brought him m&ms today to try to make up for it… not sure if he considers it an even trade.
surgery rounds were yesterday, sad, but very interesting. part of what made it interesting was, obviously, the patients we saw, but also, on this particular day they were painting the hospital. unlike in the U.S. they do not close the wing to paint, instead they paint around the patients and doctors and nurses, so as we did rounds people kept bumping into walls and doors with wet paint. the docs are examining patients with painted hands and the nurses have paint in their hair and the med students are getting it on their white coats. were the smell a little less toxic, the whole thing would have been quite comical.
a few of the more interesting surgical cases: a patient, who I noticed when they uncovered him, had wet himself. this was a full grown adult so I found that strange. turns out he’s a spinal, no feeling in his legs up to his abdomen. really tragic to see in someone that young. he looked absolutely terrified, and rightfully so. I’m not sure what they can do for him here… probably couldn’t do much more for a similar patient back home. it is patients like this that make me take a step back and appreciate my good health. we should all take a moment, far more often than we do, to appreciate how fortunate we are.
a young kid, another motor vehicle crash, who was very out of it. thu and I wanted to perform a neuro exam on him, until we realized our swahili isn’t nearly proficient enough for that. I checked his pupillary reflex and his left pupil was totally unresponsive. first time I’ve seen that.
we visited the burn unit as well. probably the most traumatizing experience I’ve had since being here. in my opinion, burns are one of the worst injuries you can sustain. so painful and completely devastating, especially when they cover large areas of the body as we saw with most of these patients. they have wire ‘tents’ on the beds, covered in blankets, to keep the patients warm without touching the raw burns. they basically try to keep the skinless areas clean and cover them in vaseline in an attempt to prevent too much water loss. frequently children, usually burned from hot oil or water because so many the people here live in tiny huts where kitchens and beds are side by side - it is all too common to see severe burns. arms, torsos, and legs, all covered in deep burns. really awful to see, and so much suffering. the worst was (warning, you might just want to skip to the next paragraph) a young girl, maybe about 1 year old, who had burns all over her face and head. when we went through our section this year on child abuse, one of the things we were taught to look for when a child comes in with burns is patterns and submersion burns (with a neat line where you can see the hand or foot was held under the boiling water). this child had a neat line all the way around her neck. the only way I can figure a child would get a burn like that would be if she was literally dangled by her feet and her head was dunked in boiling water. it is seriously too awful to think about, but something we must consider. I had dr. lee ask the mother about the burn, she said the child fell in hot oil. the problem is, there’s not exactly a social services worker here we can call. furthermore, im sure it is not the mother, sitting patiently with the child and comforting her, who is responsible, but the male of the household, whoever that might be. sadly, these cases are not unique to developing countries, they happen in the U.S. too and it is heartbreaking.
after surgery rounds, which took us through four wards and past countless terrible breaks from motor vehicle accidents, I went downstairs to catch up on peds. lost a kid last night, so that’s always hard, and you can’t help but wonder if the outcome would have been the same in a better facility. all you can do is evaluate the death, make sure no mistakes were made, and move on. apparently dr. james says they usually lose about a kid a night here. that was staggering to hear but some of the kids do come in really sick. we had a new admin there, a young child who had aspirated kerosene. that was interesting. there was a 2 year old maasai baby who weighed only 9 kilos. and another massai baby with a Hb of 1.4, low enough to warrant a blood transfusion, something you rarely see here. the family must be willing to donate in this case, blood is so scarce. we have several cases of ventricular septal defects, a heart defect, with the peds patients right now. great practice for listening to mururs but sad because there’s not much we can do for them here. we also saw our little boy with an abscess on his chin that was huge the first time we drained it, probably 40ml of puss came out. we drained it again today, so disgusting, but oddly satisfying. poor kid is never going to go to a doc again in his life, it is traumatizing, and very painful to have an abscess drained. we brought him m&ms today to try to make up for it… not sure if he considers it an even trade.
avocado pasta
dr. james lace, a pediatrician from salem, is finally here, and we’re relieved to have an english speaker around to teach us and answer our questions; someone who understands the frustrations we have with mt. meru hospital.
walked into the hospital yesterday and soon realized we were following a trail of blood. it is best to always look down when walking around the hospital, as random fluids of all colors and consistencies frequently decorate the pathways between buildings. I look up, searching for the source of the blood, and ahead of me hobbles a man clutching a cloth to his face. that explains it. he’s walking toward the “casualties” area of the hospital – comparable to the emergency room in the u.s. but really, they could have come up with a better name than casualties, am I right? a few days before, as we were walking through the reception area of the hospital, we passed a man being wheeling on a stretcher into the casualties ward. he was unconscious, covered in dirt and leaves, and foaming at the mouth. I paused, shocked at what I was seeing, then hurried to keep up with amy and thu. they hadn’t even noticed this man, though they had walked right past him. I suppose at a place like this you can go one of two ways: tunnel vision to make it easier, or eyes wide open taking in every peculiarity. I definitely pick the latter.
we shadowed dr. lace for the day. here’s an idea of the patients you see in peds icu at a government run hospital in arusah. moses is a 9 year old boy who presents with what we think is atypical pneumonia. his tb test is negative, for now, sometimes it takes weeks or even months to sero-convert, so there’s a chance he might actually have tb. we tossed around some differential diagnoses: a fungus of some sort, wegener’s granulomatosis, sarcoidosis, and the different causes of atypical pneumonia. aside from the obvious sadness that comes with seeing a sick kid, it’s pretty cool to get to HOUSE it on the wards and try to figure out what’s wrong with these kids. he was admitted the end of june, his CXR looks terrible and hasn’t improved. his HIV status is negative as far as we know. what I found remarkable was his tachypnea and tachycardia. even the next day, when he had improved some, we saw him his HR was 120 beats/min laying down, asleep. I had amy check my pulse, 68 beats/min right after walking to the hospital. poor kid. lets hope the drugs they decide to treat with are a) available (you should see the state of the pharmacy here – duka la dawa – drugs get sold for profit and aren’t available to the patients who need them), b) affordable for his family, and c) the right treatment for his ailment. dr. lace would prefer to send him to KCMC for a second opinion and better tests. it is a university-type hospital near moshi, but it’s private and about a two hour drive away and moses’ mother refuses. dr. lace says this is not uncommon and often children will die at mt meru, there in the ‘icu’, their parents unable to take them to a more capable hospital.
next patient. a 6 week old very irritable child with a temperature of 40C, not good. even worse is that the child has bulging fontonelles, and they’re pulsing. all signs are pointing to meningitis. could be encephalitis, septicemia, malaria… the idea is to rule these out, not sure how they do that here. we do a lumbar puncture on this infant. that was interesting. placed her on her side on the nurses table because there was no other stable place to set her, tried to be as sterile as possible, four of us holding her because they don’t even have lidocaine (except here they call it lignocaine) to numb the area before the huge needle is inserted into the spinal canal and you can bet she cried and squirmed. fortunately it goes well, except we get out foggy yellow csf when it should be clear. send it to the lab and the results are back the next day (surprisingly). they weren’t able to culture anything, that would be too optimistic, but we did get a low glucose and a high protein and coupled with the clinical symptoms that was enough to make the diagnosis. we had already started her on meds, even before the diagnosis was confirmed, meningitis is not something you don’t wait around to confirm… unfortunately, they messed up the dosage, so the first day she only got half the dose she should have. hopefully with proper treatment today she’ll be doing well. it scares me that simple mistakes like this, with such devastating consequences, happen at this hospital.
next we have a one year old with a massively distended abdomen. he is a maasai baby and his mother does not speak swahili. this is an interesting challenge as only one of the group of 12 following dr. lace around speaks the maasai language enough to communicate with the mothers. we get enough of the story to realize that this baby, a twin (the other twin is healthy and fine), was given some traditional maasai herbs/medicines and has since developed the distended abdomen. lamande is the herb mixed with tea, apparently very toxic. the baby also had these patterned burns scabbing on his abdomen. a very odd culture and strange traditions to an outsider such as myself who does not understand the history. it is easy to spot these people: the maasai all wear their characteristic purple and red bright plaid kangas and they have elaborate beading around their wrists, ankles, and necks and dangling from the huge holes in their ear lobes. it will be interesting to visit the maasai village we’re going with dr. lace to in about a week.
we see a small child, 15 months old, 6 kg, who looks terribly emaciated. malnutrition at its worst. and upon seeing the CXR it becomes apparent that the baby has extreme cardiomegaly. I’ve never seen heart boarders that almost stretch chest wall to chest wall. apparently cardiomegaly with malnutrition is fairly common (we’ve discussed a future research project about this with dr. lace, we’re actually in the process of sorting out several research possibilities). we discuss rickets, vitamin D and calcium deficiency. what’s interesting is that we’re probably getting more vitamin D here than we did all spring in oregon, and yet all the people here, and especially the babies, are bundled and hardly get any sun exposure. it is winter and they dress like it’s winter, though we are comfortable running around in skirts and tank tops.
we had a baby with what we thought was a UTI. to get a urine sample dr. lace wanted to put in a foley catheter. they didn’t have one, so he tried to use a feeding tube. needless to say it didn’t work. I’ve also seen an IV tube turned into a drain post-surgery using a pair of scissors and a glove for it to drain into. they get creative here. on a side note I saw a woman with a poorly done tattoo on her shoulder that said, only god can judge me, and it had a stick figure type drawing of a wine bottle being poured into a wine glass. classy.
next patient: 4 month old febrile baby who came in because the mother complained of the baby having vomiting and sob. we listen to his heart. he has a grade 4/6 holosystolic murmur. spent a long time discussing this patient and the options, the outlook doesn’t seem good at this point. the day went on like this, patient after patient, and all the while the boy with cerebral palsy, who is pretty much on the ward indefinitely, was howling and screeching, as he always does. we pretend like we don’t hear it, raise our voices and talk over the repetitive yelling, but it eats away at you, listening to him suffer like that.
then it was to the OR to spend some time with dr. lee. casting, lots of casting today. it’s interesting because they were using this yellow liquid today to knock the patients out. the problem is that the patients would still howl with pain as dr. lee manipulated the broken bone. saw more gumby limbs, it still gets me, even when I know the ulna and radius are broken all the way through, that the hand can move like it’s detached from the arm… well it is, but still, it’s weird, like an optical illusion or something. also cleaned out this old man’s infected finger. dr. lee literally pulled dead bone out of the end and flushed the finger from the inside out, it looked very unnatural and quite frankly, was disgusting.
as we left the hospital I saw a nurse carrying the autoclaved container of surgical tools on her head – how’s that for an african cliché?
now after that gross OR talk, how do you feel about talking about food? the past two nights we’ve been experimenting with food from the local stands, attempting to cook at the hostel. we can only handle fried food for so long, we’re craving fresh veggies! yesterday night we went with a sautéed assortment of vegetables from our favorite veggie stand lady down the street. it’s amazing that a zucchini, carrot and eggplant can fill us, but the fruits and veggies are all so much bigger here! we also had a lady convince us to buy three avocadoes. a single avocado here is bigger than two combined back home, and she wanted 1000 tzs for all three – that’s about 70 cents for three massive avocados, and yes, im already trying to grow an avocado tree in our room :) avocadoes = best purchase of the day, they are to die for!! i’ve never tasted something so delicious in my entire life. night one I made an improv version of an avocado bruschetta I make back home (you know what im talking about nat!) and it turned out pretty amazing considering the circumstances. we even gave some to vene, one of the women who works here, and she loved it too. the next night we decided to make pasta, and because of the abundance of avocadoes in our life, we made avocado pasta. it was basically a spaghetti version of a spring roll because we had cucumber in there too, and I have to say, of all the meals we’ve made, this one has been my favorite. yes, we’ve been trying some strange things, so far it’s worked out well… though I am waiting for the day we sit down to eat some new concoction we’ve just made and everyone takes the first bite and spits it out. but that avocado, so good I’d eat it on my breakfast cereal :) I miss breakfast cereal…
walked into the hospital yesterday and soon realized we were following a trail of blood. it is best to always look down when walking around the hospital, as random fluids of all colors and consistencies frequently decorate the pathways between buildings. I look up, searching for the source of the blood, and ahead of me hobbles a man clutching a cloth to his face. that explains it. he’s walking toward the “casualties” area of the hospital – comparable to the emergency room in the u.s. but really, they could have come up with a better name than casualties, am I right? a few days before, as we were walking through the reception area of the hospital, we passed a man being wheeling on a stretcher into the casualties ward. he was unconscious, covered in dirt and leaves, and foaming at the mouth. I paused, shocked at what I was seeing, then hurried to keep up with amy and thu. they hadn’t even noticed this man, though they had walked right past him. I suppose at a place like this you can go one of two ways: tunnel vision to make it easier, or eyes wide open taking in every peculiarity. I definitely pick the latter.
we shadowed dr. lace for the day. here’s an idea of the patients you see in peds icu at a government run hospital in arusah. moses is a 9 year old boy who presents with what we think is atypical pneumonia. his tb test is negative, for now, sometimes it takes weeks or even months to sero-convert, so there’s a chance he might actually have tb. we tossed around some differential diagnoses: a fungus of some sort, wegener’s granulomatosis, sarcoidosis, and the different causes of atypical pneumonia. aside from the obvious sadness that comes with seeing a sick kid, it’s pretty cool to get to HOUSE it on the wards and try to figure out what’s wrong with these kids. he was admitted the end of june, his CXR looks terrible and hasn’t improved. his HIV status is negative as far as we know. what I found remarkable was his tachypnea and tachycardia. even the next day, when he had improved some, we saw him his HR was 120 beats/min laying down, asleep. I had amy check my pulse, 68 beats/min right after walking to the hospital. poor kid. lets hope the drugs they decide to treat with are a) available (you should see the state of the pharmacy here – duka la dawa – drugs get sold for profit and aren’t available to the patients who need them), b) affordable for his family, and c) the right treatment for his ailment. dr. lace would prefer to send him to KCMC for a second opinion and better tests. it is a university-type hospital near moshi, but it’s private and about a two hour drive away and moses’ mother refuses. dr. lace says this is not uncommon and often children will die at mt meru, there in the ‘icu’, their parents unable to take them to a more capable hospital.
next patient. a 6 week old very irritable child with a temperature of 40C, not good. even worse is that the child has bulging fontonelles, and they’re pulsing. all signs are pointing to meningitis. could be encephalitis, septicemia, malaria… the idea is to rule these out, not sure how they do that here. we do a lumbar puncture on this infant. that was interesting. placed her on her side on the nurses table because there was no other stable place to set her, tried to be as sterile as possible, four of us holding her because they don’t even have lidocaine (except here they call it lignocaine) to numb the area before the huge needle is inserted into the spinal canal and you can bet she cried and squirmed. fortunately it goes well, except we get out foggy yellow csf when it should be clear. send it to the lab and the results are back the next day (surprisingly). they weren’t able to culture anything, that would be too optimistic, but we did get a low glucose and a high protein and coupled with the clinical symptoms that was enough to make the diagnosis. we had already started her on meds, even before the diagnosis was confirmed, meningitis is not something you don’t wait around to confirm… unfortunately, they messed up the dosage, so the first day she only got half the dose she should have. hopefully with proper treatment today she’ll be doing well. it scares me that simple mistakes like this, with such devastating consequences, happen at this hospital.
next we have a one year old with a massively distended abdomen. he is a maasai baby and his mother does not speak swahili. this is an interesting challenge as only one of the group of 12 following dr. lace around speaks the maasai language enough to communicate with the mothers. we get enough of the story to realize that this baby, a twin (the other twin is healthy and fine), was given some traditional maasai herbs/medicines and has since developed the distended abdomen. lamande is the herb mixed with tea, apparently very toxic. the baby also had these patterned burns scabbing on his abdomen. a very odd culture and strange traditions to an outsider such as myself who does not understand the history. it is easy to spot these people: the maasai all wear their characteristic purple and red bright plaid kangas and they have elaborate beading around their wrists, ankles, and necks and dangling from the huge holes in their ear lobes. it will be interesting to visit the maasai village we’re going with dr. lace to in about a week.
we see a small child, 15 months old, 6 kg, who looks terribly emaciated. malnutrition at its worst. and upon seeing the CXR it becomes apparent that the baby has extreme cardiomegaly. I’ve never seen heart boarders that almost stretch chest wall to chest wall. apparently cardiomegaly with malnutrition is fairly common (we’ve discussed a future research project about this with dr. lace, we’re actually in the process of sorting out several research possibilities). we discuss rickets, vitamin D and calcium deficiency. what’s interesting is that we’re probably getting more vitamin D here than we did all spring in oregon, and yet all the people here, and especially the babies, are bundled and hardly get any sun exposure. it is winter and they dress like it’s winter, though we are comfortable running around in skirts and tank tops.
we had a baby with what we thought was a UTI. to get a urine sample dr. lace wanted to put in a foley catheter. they didn’t have one, so he tried to use a feeding tube. needless to say it didn’t work. I’ve also seen an IV tube turned into a drain post-surgery using a pair of scissors and a glove for it to drain into. they get creative here. on a side note I saw a woman with a poorly done tattoo on her shoulder that said, only god can judge me, and it had a stick figure type drawing of a wine bottle being poured into a wine glass. classy.
next patient: 4 month old febrile baby who came in because the mother complained of the baby having vomiting and sob. we listen to his heart. he has a grade 4/6 holosystolic murmur. spent a long time discussing this patient and the options, the outlook doesn’t seem good at this point. the day went on like this, patient after patient, and all the while the boy with cerebral palsy, who is pretty much on the ward indefinitely, was howling and screeching, as he always does. we pretend like we don’t hear it, raise our voices and talk over the repetitive yelling, but it eats away at you, listening to him suffer like that.
then it was to the OR to spend some time with dr. lee. casting, lots of casting today. it’s interesting because they were using this yellow liquid today to knock the patients out. the problem is that the patients would still howl with pain as dr. lee manipulated the broken bone. saw more gumby limbs, it still gets me, even when I know the ulna and radius are broken all the way through, that the hand can move like it’s detached from the arm… well it is, but still, it’s weird, like an optical illusion or something. also cleaned out this old man’s infected finger. dr. lee literally pulled dead bone out of the end and flushed the finger from the inside out, it looked very unnatural and quite frankly, was disgusting.
as we left the hospital I saw a nurse carrying the autoclaved container of surgical tools on her head – how’s that for an african cliché?
now after that gross OR talk, how do you feel about talking about food? the past two nights we’ve been experimenting with food from the local stands, attempting to cook at the hostel. we can only handle fried food for so long, we’re craving fresh veggies! yesterday night we went with a sautéed assortment of vegetables from our favorite veggie stand lady down the street. it’s amazing that a zucchini, carrot and eggplant can fill us, but the fruits and veggies are all so much bigger here! we also had a lady convince us to buy three avocadoes. a single avocado here is bigger than two combined back home, and she wanted 1000 tzs for all three – that’s about 70 cents for three massive avocados, and yes, im already trying to grow an avocado tree in our room :) avocadoes = best purchase of the day, they are to die for!! i’ve never tasted something so delicious in my entire life. night one I made an improv version of an avocado bruschetta I make back home (you know what im talking about nat!) and it turned out pretty amazing considering the circumstances. we even gave some to vene, one of the women who works here, and she loved it too. the next night we decided to make pasta, and because of the abundance of avocadoes in our life, we made avocado pasta. it was basically a spaghetti version of a spring roll because we had cucumber in there too, and I have to say, of all the meals we’ve made, this one has been my favorite. yes, we’ve been trying some strange things, so far it’s worked out well… though I am waiting for the day we sit down to eat some new concoction we’ve just made and everyone takes the first bite and spits it out. but that avocado, so good I’d eat it on my breakfast cereal :) I miss breakfast cereal…
Tuesday, July 13, 2010
a knock in the night
just when i think i’m having a day in tanzania with nothing worth blogging about, something happens and i’ve got to record it. the town is now very familiar and comfortable, and things we were shocked and amazed by at the beginning of our trip have lost their novelty, for the most part. but there are still surprises, and last night was a perfect example of : t.i.a.
I woke to knocking, sort of. I was not startled out of my sleep, rather gently roused to the point where I became acutely aware that the repetitive pounding was maybe not a part of my dream and in fact coming from the door to our room. that inbetween place is always interesting - when your dreams blur with reality and it takes a while to sort out which is which. I open my eyes to darkness and silence, maybe it was just a dream after all… I rolled over, closed my eyes and prepared to fall back to sleep. knock knock knock! annnddd we’re apparently talking real life here, ok, I get it, clearly someone wants into our room. but who? how late is it? my mind is telling me that answering the door is not a good idea. thu is getting up, sleepwalking? I’m still in a fog. she moves to the door and reaches for the handle as I hear amy say “wait!”… she agrees, you cannot just open doors here in the middle of the night (especially after the scare daaimah had). then we hear deepal’s voice. thu unlocks the door to let him in. he’s a shadow, the light from the hall shines in around him, he sounds as out of it as we feel. what time is it? two in the morning? three? almost morning? he says “sister rose got bit by something and came knocking on my door to get help” leave it to the dental student to come running to the med students for assistance in the event of an emergency :) “she thought I was a medical student and she needs medical students or something”. you should have been here to watch the scene that followed. the three of us wrestling with our mosquito nets, trying to ask deep questions he didn’t have the answers to, shuffling through our supplies bags to see what we brought that might be useful in the event of a bite. all of it seemed to happen in slow motion, and I’m quite sure my eyes were closed until about the time we were walking downstairs. quiet darkness. we’re led outside, into the noisy, cool night, and the real story unfolds…
a family from poland was staying at the hostel that night, and unfortunately for them they had been put in the rat room. yes, we have a room we call the rat room because when the canadians were staying there, the boys’ room was infested with huge rats. we took their word for it and didn’t worry much because our room is the main building and on the second floor. this poor, worried family, the mother, father and three kids, sleeping peacefully in the rat room when something jumps onto the bed and bites/scratches the mom’s finger. we’re getting this story from one of the sons, his english is alright but his accent is thick and the whole family is frantic with worry. the mom is sitting in the back seat of a safari-type jeep, she looks beyond distraught. she unfolds the dirty handkerchief from around her finger. there is certainly a scratch/bite but it is not actively bleeding. we were hoping it would still be bleeding, at least then we could flush it out, try to clean it better. they had taken her to a hospital where the doc had wanted to start an IV but failed. it looked like the finger had been cleaned with iodine. what were they trying to give her? we asked. the husband pulled a small vial from his pocket – hydrocortisone? seriously? what good’s that gonna do? this woman needs to be prophylaxed for rabies, given oral penicillin to treat the bacteria that causes rate bite fever, but no, she does not need an antihistamine.
we’re doing our best to council her, three babbling, half-asleep, medstudents who have only completed their first year and are examining the bite in the dark with a flashlight while taking a history from a teenage guy who doesn’t really speak english. what an ideal situation – not! probably the only good we did was to put them at ease a little and explain that she is in no immediate danger, they could wait until morning to seek better medical attention. the family thanked us and left, in search of a rat-less hotel to spend the rest of the night. well centre house hostel, this isn’t exactly going to do wonders for your ratings…
I woke to knocking, sort of. I was not startled out of my sleep, rather gently roused to the point where I became acutely aware that the repetitive pounding was maybe not a part of my dream and in fact coming from the door to our room. that inbetween place is always interesting - when your dreams blur with reality and it takes a while to sort out which is which. I open my eyes to darkness and silence, maybe it was just a dream after all… I rolled over, closed my eyes and prepared to fall back to sleep. knock knock knock! annnddd we’re apparently talking real life here, ok, I get it, clearly someone wants into our room. but who? how late is it? my mind is telling me that answering the door is not a good idea. thu is getting up, sleepwalking? I’m still in a fog. she moves to the door and reaches for the handle as I hear amy say “wait!”… she agrees, you cannot just open doors here in the middle of the night (especially after the scare daaimah had). then we hear deepal’s voice. thu unlocks the door to let him in. he’s a shadow, the light from the hall shines in around him, he sounds as out of it as we feel. what time is it? two in the morning? three? almost morning? he says “sister rose got bit by something and came knocking on my door to get help” leave it to the dental student to come running to the med students for assistance in the event of an emergency :) “she thought I was a medical student and she needs medical students or something”. you should have been here to watch the scene that followed. the three of us wrestling with our mosquito nets, trying to ask deep questions he didn’t have the answers to, shuffling through our supplies bags to see what we brought that might be useful in the event of a bite. all of it seemed to happen in slow motion, and I’m quite sure my eyes were closed until about the time we were walking downstairs. quiet darkness. we’re led outside, into the noisy, cool night, and the real story unfolds…
a family from poland was staying at the hostel that night, and unfortunately for them they had been put in the rat room. yes, we have a room we call the rat room because when the canadians were staying there, the boys’ room was infested with huge rats. we took their word for it and didn’t worry much because our room is the main building and on the second floor. this poor, worried family, the mother, father and three kids, sleeping peacefully in the rat room when something jumps onto the bed and bites/scratches the mom’s finger. we’re getting this story from one of the sons, his english is alright but his accent is thick and the whole family is frantic with worry. the mom is sitting in the back seat of a safari-type jeep, she looks beyond distraught. she unfolds the dirty handkerchief from around her finger. there is certainly a scratch/bite but it is not actively bleeding. we were hoping it would still be bleeding, at least then we could flush it out, try to clean it better. they had taken her to a hospital where the doc had wanted to start an IV but failed. it looked like the finger had been cleaned with iodine. what were they trying to give her? we asked. the husband pulled a small vial from his pocket – hydrocortisone? seriously? what good’s that gonna do? this woman needs to be prophylaxed for rabies, given oral penicillin to treat the bacteria that causes rate bite fever, but no, she does not need an antihistamine.
we’re doing our best to council her, three babbling, half-asleep, medstudents who have only completed their first year and are examining the bite in the dark with a flashlight while taking a history from a teenage guy who doesn’t really speak english. what an ideal situation – not! probably the only good we did was to put them at ease a little and explain that she is in no immediate danger, they could wait until morning to seek better medical attention. the family thanked us and left, in search of a rat-less hotel to spend the rest of the night. well centre house hostel, this isn’t exactly going to do wonders for your ratings…
a run in arusha
woke up to the smell of campfire and for a moment I was in the woods, somewhere in oregon, rising with the sun to the smell of someone starting breakfast over an open fire. I went with that association, breathed in the smoky scent wafting up from the fire burning outside, cooking the mush they serve to the four guard dogs. I realize that the birds, not the smell, had awakened me. there are these crazy birds here with long necks and even longer beaks and they’re big… but it’s their squawk, not their appearance, that is what makes them worth remembering, or at least difficult to forget. you have me make this noise for you when I get home and you won’t believe how obnoxious it is (or how ridiculous I am :) sounds more like a dying bird than anything else. bagoochhh!!! so loud and terribly annoying. they wake us up a lot, but will visit the hostel at pretty much any time of the day. usually we will hear their calls a few times, then eventually hear the crack of a rock or two on the roof where they like to perch, and then angry squawking as they fly away, startled by the rocks one of the workers here has chucked at them.
our afternoon run today was pretty typical. thu and i (amy needed a nap) start uphill because for some reason we’ve decided we like running clockwise better than counter clockwise. we turn every head we pass. we see the occasional mzungu and exchange friendly smiles, being in a foreign place gives us a bond. we pass some locals who mockingly cheer for us, in a friendly, teasing way, and offer their fists to pound our effort. we laugh and reciprocate, and they are entertained. second lap and we’re gaining on three young boys, they’ve spotted us and are anxiously awaiting our approach. as we come up to them i extend my hand to high five the nearest boy and he’s thrilled. as thu and i run by they begin to a jog next to us. “yes” i think “new opponents”. i smile deviously, they sense what i’m about to do and we all break into a sprint together. we’re flying down the street and they’re falling behind and i’m looking over my shoulder as i sprint, egging them on, but they can’t catch me :) i run until i’m panting then turn around and backtrack, both hands raised to high five each of them. i tell them “very good” in swahili and we’ve all got the biggest smiles on our faces. there you have it, my first victory in africa. guess i need to race opponents that only come up to my shoulder more often :) it’s good for them though, every boy needs his butt kicked by a girl now and again. we finished our run as the sun was setting orange over the hostel. one of the best sunsets I’ve seen so far.
it’s time to shower and I’ve finally got it figured out so that I get a mostly warm shower. the catch is that the drainage in the warm shower leads into the cold shower and it gets backed up. so you must choose, either you get a shower that drains and has decent water pressure, but your shower is cold, or you get a warm trickle of a shower while you stand ankle deep in dirty water. I think it’s a toss up. and today was a particularly fun shower because these tiny ants were running amuck around the shower head, and every once in a while one would get too close to the stream of water and get washed down onto me. awesome, right? put your hands out to cup some water to splash on your face and ants appear in the water accumulating in your hands. so fresh and so clean clean.
spain v netherlands was an epic game. we were faithfully rooting for spain as we watched the game via projector on a huge screen set up in a thatched hut not far from the hostel. t.i.a. lots of wzungus at the game and I was wishing an africa team was still in it, would have been wild to watch here with a ton of locals. either way though, africa loves its futbol and was out in full force cheering their favored team. we were quite happy with the win :)
our afternoon run today was pretty typical. thu and i (amy needed a nap) start uphill because for some reason we’ve decided we like running clockwise better than counter clockwise. we turn every head we pass. we see the occasional mzungu and exchange friendly smiles, being in a foreign place gives us a bond. we pass some locals who mockingly cheer for us, in a friendly, teasing way, and offer their fists to pound our effort. we laugh and reciprocate, and they are entertained. second lap and we’re gaining on three young boys, they’ve spotted us and are anxiously awaiting our approach. as we come up to them i extend my hand to high five the nearest boy and he’s thrilled. as thu and i run by they begin to a jog next to us. “yes” i think “new opponents”. i smile deviously, they sense what i’m about to do and we all break into a sprint together. we’re flying down the street and they’re falling behind and i’m looking over my shoulder as i sprint, egging them on, but they can’t catch me :) i run until i’m panting then turn around and backtrack, both hands raised to high five each of them. i tell them “very good” in swahili and we’ve all got the biggest smiles on our faces. there you have it, my first victory in africa. guess i need to race opponents that only come up to my shoulder more often :) it’s good for them though, every boy needs his butt kicked by a girl now and again. we finished our run as the sun was setting orange over the hostel. one of the best sunsets I’ve seen so far.
it’s time to shower and I’ve finally got it figured out so that I get a mostly warm shower. the catch is that the drainage in the warm shower leads into the cold shower and it gets backed up. so you must choose, either you get a shower that drains and has decent water pressure, but your shower is cold, or you get a warm trickle of a shower while you stand ankle deep in dirty water. I think it’s a toss up. and today was a particularly fun shower because these tiny ants were running amuck around the shower head, and every once in a while one would get too close to the stream of water and get washed down onto me. awesome, right? put your hands out to cup some water to splash on your face and ants appear in the water accumulating in your hands. so fresh and so clean clean.
spain v netherlands was an epic game. we were faithfully rooting for spain as we watched the game via projector on a huge screen set up in a thatched hut not far from the hostel. t.i.a. lots of wzungus at the game and I was wishing an africa team was still in it, would have been wild to watch here with a ton of locals. either way though, africa loves its futbol and was out in full force cheering their favored team. we were quite happy with the win :)
Sunday, July 11, 2010
tea water
I find myself, once again, packed shoulder to shoulder on a dala dala, headed out of arusha. it’s a beautiful day and we’re going with deepaul to visit the kids in maji chai (a town named after the water looking like tea). our destination is CCF, children for children’s future. this is an organization that was started by a german guy a few years back, and deepaul worked with them last year. the program finds kids, particularly boys, who are on the streets (using drugs, not going to school, headed down a bad path), and takes them in to assess how badly they want to attend school and get away from their street life. if the boys are judged to want to change, they are sent to this facility (if you can call it that, it’s basically a few buildings, on a donated piece of land, far enough from the city that the boys can’t fall back into their street life habits). the organization helps pay to put them through school and it is a place for them to learn (for the younger boys), live, eat and learn responsibility (they do their own laundry and clean their dormitories, etc). the boys range in age from 8 to 20 and there are about thirty of them total. I was asking one of the volunteers about the dynamic and she said it’s very much a big family. they give each other a hard time but are never mean, and they watch out for their “brothers”. I definitely got that vibe from the time we spent there today. they are all very happy with their living situation, and they are extremely friendly and sweet boys.
we got a tour from a few of the boys, their english is very impressive. a puppy named charlie was running around with us and despite my best efforts I caved and petted him. that puppy followed me the rest of the day. the boys thought it was funny we say ‘bunk beds’ because they call them double deckers. they also found it entertaining that we call it ‘wetting the bed’ when you pee in the bed (they were explaining to us why some of the beds were covered in plastic). they’ve got basketball hoops but no basketball, which seems a little depressing except they’re all so into futbol I don’t think they notice. it was laundry day so a bunch of the boys were helping out with that. one of the boys, an eleven year old named davis, was in the back scrubbing on some bed sheets. katie, one of the volunteers, and a nurse, had brought me back to see him after explaining that one of her boys had +3 pitting edema and an all over skin fungal infection, plus an eye infection. the story is that him and his brother were left there with a note asking if they could be cared for. the volunteers agreed to take them in (this was about a week ago) and though his brother is doing well, he has all of these opportunistic infections that suggest an immune-compromised state. katie says he’s tested HIV negative, so that is good, but doesn’t help us explain the infections. the edema was incredible. on this tiny boy who’s the size of a 6 year old despite being half a decade older than that, in addition to the dark fungus on his head and back and extremities (tinea capitis/ tinea corporis is what I was thinking, or maybe on the head black piedra- it was getting better because they had shaved his head to try to treat it). as for the edema, it was beyond +3, just these massively swollen feet, ankles and calves. davis didn’t speak english so we brought one of the boys to help us ask some questions and give us a rough translation of his answers. it didn’t sounds like the swelling was getting any better, but it also didn’t appear to be painful. you have to consider that this boy was severely malnourished when he came in, so it could have been an issue with protein deficient.. however, after a week on a good diet it should resolve, or at least begin to, and they hadn’t seen any improvement. my first thought was wuchereria bancrofti, a roundworm that causes filariasis (more commonly known as elephantiasis). infection with these nematodes can cause lymphatic obstruction by the microfilaria, which leads to lymphadentitis/the severe edema we see on his feet and legs. the vector is the mosquito and it is often seen in urban areas of africa. might just fit the bill but I don’t know for sure. I’m open to other suggestions. I told katie I’d get back to her before she takes him to the doctor again this coming week.
as amy kicked the soccer ball around with some of the boys, thu and I ventured to the kitchen. there we found two sisters, 13 and 16, the only girls at CCF aside from the mama who looks after everyone (and the two female volunteers). these girls spoke a little english, and we managed to communicate that we’d like to help with lunch. the next hour or so was us struggling to keep up with these girls as they busily prepared food for everyone (including a group of 6 volunteers that had come in for the day, and get this, two of them were the americans, tiffany and brian, we had randomly traveled to moshi with the weekend before… small place). we were making ugali and sukuma wiki (literally ‘push week’) and chicken. the chicken had been frozen somewhere, so it was a ball of several plucked chicken bodies. I couldn’t figure it out at first glance, and when I pointed and asked about these strange long things of meat they said they were the necks. mmm. t.g.i.v. (thank goodness im vegetarian :) the uglai and sukuma wiki we tried when andrew was here and I really enjoy it, so I was excited to learn to cook it today. it is very bland, and thu and amy aren’t really fans, but i will eat seconds if given the opportunity, it’s fun local finger food! we boiled a bunch of water in this ginormous pot over a wood fire and then slowly added the maize flour as we stirred. ‘not bad’ thu and I were thinking and we took turns with the four foot long wooden spoon. then more flour was added, and more, and soon the consistency was really thickening up and the girls were laughing as we struggled to stir. they’d take the spoon from us, correct the placement of our hands to hold it and get the best leverage, and then they’d just go at it, like it was nothing. so impressive. thu and I are literally crying from the smoke burning our eyes and we’re struggling to mix in the newly added flour and these teenage girls made it look effortless. we had a really good time, we were laughing and making fun of how incompetent we were, and the four of us the whole time were communicating with a mix of english and swahili words that were familiar. it was comical and fortunately, the final product was perfect, if I do say so myself. there’s something extra satisfying about eating something you’ve labored for, and we made enough to feed all forty plus people who were there. probably my favorite lunch since arriving here, and an incredible experience that I cannot believe is daily life for these young girls. oh, and naturally I taught them to lick the spoon... how american of me.
I was talking with katie later today while we watched the boys play futbol (amy and thu were in there too representing the girls… andrew had said, when we played in the village yesterday, that it was the first game of futbol he had played in tanzania where girls were allowed to play. what?!) in a big field that sits in the shadow of both mount meru and kili. she told me that a bunch of the boys were recently circumcised so they’ve been walking around a little funny lately. apparently a group of them, ages 8 to 16, were done, though they usually do it around age 8 or 9, similar to in the philippines. it’s part of becoming a man and the boys actually request it to be done. it is common place in the culture (which is wonderful because circumcision can greatly reduce the transmission of HIV), and CCF is great about sending the boys to the hospital to be circumcised, which greatly reduces complications.
on that fun note, im about to wrap up this blog entry. just wanted to say we went to dinner with a few of the canadians tonight and deep ordered warthog. I’m coming up on a decade as a vegetarian, but when odd meats present themselves I have no choice but to break my lifestyle code and give it a try. the last time I did this was in the philippines when I tried ostrich – not impressed. today I had a tiny bite of pumba (when you put it that way you feel kinda bad about it), and I must say, if I ever revert back to the way of the carnivore, I will definitely find myself some good warthog to enjoy, it was tasty! a.w.a. africa wins again :) whit, don’t judge me! hope all’s well back home, missing everyone! bye for now…
we got a tour from a few of the boys, their english is very impressive. a puppy named charlie was running around with us and despite my best efforts I caved and petted him. that puppy followed me the rest of the day. the boys thought it was funny we say ‘bunk beds’ because they call them double deckers. they also found it entertaining that we call it ‘wetting the bed’ when you pee in the bed (they were explaining to us why some of the beds were covered in plastic). they’ve got basketball hoops but no basketball, which seems a little depressing except they’re all so into futbol I don’t think they notice. it was laundry day so a bunch of the boys were helping out with that. one of the boys, an eleven year old named davis, was in the back scrubbing on some bed sheets. katie, one of the volunteers, and a nurse, had brought me back to see him after explaining that one of her boys had +3 pitting edema and an all over skin fungal infection, plus an eye infection. the story is that him and his brother were left there with a note asking if they could be cared for. the volunteers agreed to take them in (this was about a week ago) and though his brother is doing well, he has all of these opportunistic infections that suggest an immune-compromised state. katie says he’s tested HIV negative, so that is good, but doesn’t help us explain the infections. the edema was incredible. on this tiny boy who’s the size of a 6 year old despite being half a decade older than that, in addition to the dark fungus on his head and back and extremities (tinea capitis/ tinea corporis is what I was thinking, or maybe on the head black piedra- it was getting better because they had shaved his head to try to treat it). as for the edema, it was beyond +3, just these massively swollen feet, ankles and calves. davis didn’t speak english so we brought one of the boys to help us ask some questions and give us a rough translation of his answers. it didn’t sounds like the swelling was getting any better, but it also didn’t appear to be painful. you have to consider that this boy was severely malnourished when he came in, so it could have been an issue with protein deficient.. however, after a week on a good diet it should resolve, or at least begin to, and they hadn’t seen any improvement. my first thought was wuchereria bancrofti, a roundworm that causes filariasis (more commonly known as elephantiasis). infection with these nematodes can cause lymphatic obstruction by the microfilaria, which leads to lymphadentitis/the severe edema we see on his feet and legs. the vector is the mosquito and it is often seen in urban areas of africa. might just fit the bill but I don’t know for sure. I’m open to other suggestions. I told katie I’d get back to her before she takes him to the doctor again this coming week.
as amy kicked the soccer ball around with some of the boys, thu and I ventured to the kitchen. there we found two sisters, 13 and 16, the only girls at CCF aside from the mama who looks after everyone (and the two female volunteers). these girls spoke a little english, and we managed to communicate that we’d like to help with lunch. the next hour or so was us struggling to keep up with these girls as they busily prepared food for everyone (including a group of 6 volunteers that had come in for the day, and get this, two of them were the americans, tiffany and brian, we had randomly traveled to moshi with the weekend before… small place). we were making ugali and sukuma wiki (literally ‘push week’) and chicken. the chicken had been frozen somewhere, so it was a ball of several plucked chicken bodies. I couldn’t figure it out at first glance, and when I pointed and asked about these strange long things of meat they said they were the necks. mmm. t.g.i.v. (thank goodness im vegetarian :) the uglai and sukuma wiki we tried when andrew was here and I really enjoy it, so I was excited to learn to cook it today. it is very bland, and thu and amy aren’t really fans, but i will eat seconds if given the opportunity, it’s fun local finger food! we boiled a bunch of water in this ginormous pot over a wood fire and then slowly added the maize flour as we stirred. ‘not bad’ thu and I were thinking and we took turns with the four foot long wooden spoon. then more flour was added, and more, and soon the consistency was really thickening up and the girls were laughing as we struggled to stir. they’d take the spoon from us, correct the placement of our hands to hold it and get the best leverage, and then they’d just go at it, like it was nothing. so impressive. thu and I are literally crying from the smoke burning our eyes and we’re struggling to mix in the newly added flour and these teenage girls made it look effortless. we had a really good time, we were laughing and making fun of how incompetent we were, and the four of us the whole time were communicating with a mix of english and swahili words that were familiar. it was comical and fortunately, the final product was perfect, if I do say so myself. there’s something extra satisfying about eating something you’ve labored for, and we made enough to feed all forty plus people who were there. probably my favorite lunch since arriving here, and an incredible experience that I cannot believe is daily life for these young girls. oh, and naturally I taught them to lick the spoon... how american of me.
I was talking with katie later today while we watched the boys play futbol (amy and thu were in there too representing the girls… andrew had said, when we played in the village yesterday, that it was the first game of futbol he had played in tanzania where girls were allowed to play. what?!) in a big field that sits in the shadow of both mount meru and kili. she told me that a bunch of the boys were recently circumcised so they’ve been walking around a little funny lately. apparently a group of them, ages 8 to 16, were done, though they usually do it around age 8 or 9, similar to in the philippines. it’s part of becoming a man and the boys actually request it to be done. it is common place in the culture (which is wonderful because circumcision can greatly reduce the transmission of HIV), and CCF is great about sending the boys to the hospital to be circumcised, which greatly reduces complications.
on that fun note, im about to wrap up this blog entry. just wanted to say we went to dinner with a few of the canadians tonight and deep ordered warthog. I’m coming up on a decade as a vegetarian, but when odd meats present themselves I have no choice but to break my lifestyle code and give it a try. the last time I did this was in the philippines when I tried ostrich – not impressed. today I had a tiny bite of pumba (when you put it that way you feel kinda bad about it), and I must say, if I ever revert back to the way of the carnivore, I will definitely find myself some good warthog to enjoy, it was tasty! a.w.a. africa wins again :) whit, don’t judge me! hope all’s well back home, missing everyone! bye for now…
this is africa
t.i.a. has fast become our saying for the trip. we use t.i.a. when we find ourselves in any of a number of situations you’d never imagine happening back home. here is the story of our friday to give you an idea of what im talking about. breakfast with the gang as usual (white bread, fried egg and tea is getting old real quick but we’re thankful we have someone providing us with breakfast each morning so we can’t complain), then a quick trip to the super market to get some treats for the dental students. they’ve been stranded in the hills for a week now (by the way they talk you’d think it’s been at least a month), and what are the girls texting us asking for? chocolate, pringles, and wine… obviously. we headed out on a dala dala with huge letters on the front labeling it “BAD BOY”. we were lucky to each get a seat, or at least part of one, usually people are packed in and standing over you, sitting on you, and hanging out the door. the dala dala is similar in size and appearance to a VW van but has rows of tiny seats packed into a place far too small for the number of people they cram inside. at the next stop a man and woman climbed in with their child. as they moved to the back where we were sitting, the dala dala started up and they each lunged for a seat, placing their child directly in amy’s lap as they sat down. it was so matter of fact, like the dad had this plan to set his son on the lap of a mzungu even before setting foot on the dala dala. we laughed and went with it, playing with the kid until he fell asleep to the bums and swerves of the vehicle. bob marley was blasting, pretty typical, in my dala dala experiences the music is always good. here’s how the dala dala works: there’s a driver and then there’s a guy who rides around in the back with all of the passengers. his job is to hang out the door or window looking for more people to cram inside the already packed bus. he jumps out and loads people on (with their produce, chickens, kids or goats) and then barely leaping into the open door as the dala dala speeds off. he is also responsible for collecting the fare, which he accomplishes by jingling a fist full of shilling coins in the face of each passenger until they fork over what they owe for the cramped ride. the dala dala is probably my second favorite mode of transportation in tanzania. I sing to the music while taking in the view, praying we don’t crash, and offering gum to all of my neighbors… what more could you ask for?
a 20 minute or so ride and we were at a transition point where we climbed out and proceeded to hop on the back of one of the variety of motorcycles parked and ready to take people up to the village in the jungle at the base of mount meru. I scoped out the bikes, picked one that I liked, pointed at the guy as I made my best serious eye contact and said “pole pole rafiki” (pronounced polay polay which means slowly). he offered me his helmet, which I took, unsure of how this ride would go. i hopped on the back and yes, was back in my bliss of riding bikes, no surprise there. I miss motorcycles in my life!! this is hands down the best way to see the countryside, and no question my favorite mode of transportation here, or really anywhere for that matter. I was catching bugs in my teeth I was smiling so big as we cruised up the winding road. It soon became apparent that I did not need to be worried about my guy being a crazy driver, the bikes are little with tiny engines that limit our speed. though faster would have been more fun, it was the perfect speed for waving at locals, giving the ever-popular thumbs up, and taking out my camera to video the experience (remind you of the habo habos in cebu, lo?)
once we regrouped at the hospital (amy was overwhelmed with the motorcycles and opted to take a dala dala up and deep – did I mention we call deepaul deep? I think so - joined her), we went for a mini tour of the place, saw the dental girls hard at work pulling teeth in a tiny room by headlamp light since the electricity had gone out. we walked up to the house where they are staying for the two weeks they spend at this hospital and I’m very certain, as are they, that the place is haunted. they sleep on old metal framed hospital beds with rolling wheels and the rooms are dark and drafty. of course we decided to explore the attic, big mistake. you walk up this steep narrow staircase and at the top, in this huge empty dark room lit only at one end by a small window, there is a wooden baby crib and tiny bed frame. yeah, I was back downstairs faster than you could say horror film :)
the area was beautiful, set back on this hillside surrounded by jungle. we hiked up until we found the cliché of all african villages, a futbol field on a crooked hill with a pile of rocks marking the two goal posts and a hodgepodge of children chasing after a miniature sized and semi-flat yellow soccer ball. we had no choice but to join in and all I can say is, the kids have got skillzzz!! we had a blast. every once in a while the ball would get kicked off the “field”, didn’t matter, they’d chase it down and keep playing (pretty much the only out of bounds was the clean laundry drying in one of the front yards). the cow feeding nearby ran interference on occasion and I think might have gotten more touches on the ball than me, but who’s counting ;) I was more about the congratulations high fives and the celebratory victory dance post goal (which the kids thought was really entertaining). aside from navigating the rugged terrain, you just had to be careful to enjoy the cow pies randomly distributed throughout the field. Good thing the kids we’re playing in…. oh wait, they were all playing in flip flops and a good number had kicked those off in the interest of speed. nothing says village soccer like cow poop between your toes. we played until we were flushed in the face and sweaty, then reluctantly said our goodbyes to our new friends (all probably about waist high and with footwork that would impress the pros). we headed for home shortly after, which entailed, not a motorbike ride down the mountain (too bad), but a coast in the oldest sedan still in running condition today. this thing had three rows of seats craftily fit into the tiny car and we had 12 people piled into a car meant to fit five, hakuna matata. we did not drive down the main road, no, we coasted down in neutral. I feared for my life probably only twice during the ride, and both times involved massive trucks coming the other direction. these are the moments we look at each other, say t.i.a., and laugh! creative family to come up with this fuel saving plan, and they’ve got the coasting to a science.
my favorite thing about arusha? the people. I’m sure you’ve picked up that we end up having random conversations pretty much on a daily basis. everyone is so friendly and it makes me want to change the way I treat strangers back in the states. Im usually all about striking up a conversation with anyone, but they take it to a whole different level here. example 1) old woman walks past us at the hospital today, she puts her arm around me, looks me straight in the eye (well, sort of, her left eye faced laterally, so she was technically only making eye contact with the right) and says something in swahili, I just return her toothless smile with a real big smile of my own and wait for andrew to translate (he’s been handy to have around as his swahili is really good from two years living in tanzania). “she says she loves you” and as he tell us this she is shaking all of our hands saying more things in swahili. I think I might love her too. example 2) we get our water in the hostel from a water cooler downstairs. the staff boil the water for us and we just fill our water bottles (and wait for it to cool… oh, and hope they’ve boiled it properly, which so far they haven’t let us down). anyway, sent amy and andrew down there to get some water today while thu and I napped (late night last night and early morning meant we got about 3 hours of sleep and we were desperately in need of nap time today). they came back up and along with our water delivered this message “vene says to tell you that god loves you” (vene is one of the women who works here). alright then! example 3) on our return trip from the hillside hospital today we were between coasting sedan and dala dala and this guy comes up to chat us on the road (typical) and he’s wearing one flip flop and one old black leather shoe without the laces and when andrew asks him about it he says he’s getting the other polished (this was most definitely his standard response to a question im sure he gets multiple times a day). anyway so he’s speaking to andrew in swahili and he’s pointing at me and andrew tells me he’s saying he loves me. so much love in this city. I hold up my left hand where I have a cheap, old ring strategically placed on my ring finger (word to all you single ladies out there, fake wedding ring in africa will save you! seriously, show the ring and you don’t have to say anything, the guys will leave you alone. amy thu and I have all found this very useful on countless occasions, particularly with, of all people, the creepy docs at the hospital who seem to really have a thing for thu - then again all the tanzanians seem to love thu the most)… this guy says something sounding a little disappointed, then lights up as he asks a question to andrew. I inquire as to what he said, andrew tells me “he wants to know if you have a younger sister”. t.i.a. and that’s how the tanzanian men work around here folks!
peaceful night with a few of the canadians who came back down to our beloved hostel for the weekend. live music at an open air restaurant, the guy was good too, really good, and he played for hours just a guitar and his incredible voice. I’m all about the stars here because there are lots, so I spent a good amount of time laying on the plush couch starring up at the southern cross (which I’ve seen for the first time in my life here, amazing!), and watching the stars move across the sky. the trees looked alive as the wind tousled the highest branches and huge bats swooped between the stars in search of dinner. it felt almost like home. it was a cool night and the sky looked a little unfamiliar without the big dipper, but the music was comforting and it felt like something I’d do during an oregon summer back home.
a 20 minute or so ride and we were at a transition point where we climbed out and proceeded to hop on the back of one of the variety of motorcycles parked and ready to take people up to the village in the jungle at the base of mount meru. I scoped out the bikes, picked one that I liked, pointed at the guy as I made my best serious eye contact and said “pole pole rafiki” (pronounced polay polay which means slowly). he offered me his helmet, which I took, unsure of how this ride would go. i hopped on the back and yes, was back in my bliss of riding bikes, no surprise there. I miss motorcycles in my life!! this is hands down the best way to see the countryside, and no question my favorite mode of transportation here, or really anywhere for that matter. I was catching bugs in my teeth I was smiling so big as we cruised up the winding road. It soon became apparent that I did not need to be worried about my guy being a crazy driver, the bikes are little with tiny engines that limit our speed. though faster would have been more fun, it was the perfect speed for waving at locals, giving the ever-popular thumbs up, and taking out my camera to video the experience (remind you of the habo habos in cebu, lo?)
once we regrouped at the hospital (amy was overwhelmed with the motorcycles and opted to take a dala dala up and deep – did I mention we call deepaul deep? I think so - joined her), we went for a mini tour of the place, saw the dental girls hard at work pulling teeth in a tiny room by headlamp light since the electricity had gone out. we walked up to the house where they are staying for the two weeks they spend at this hospital and I’m very certain, as are they, that the place is haunted. they sleep on old metal framed hospital beds with rolling wheels and the rooms are dark and drafty. of course we decided to explore the attic, big mistake. you walk up this steep narrow staircase and at the top, in this huge empty dark room lit only at one end by a small window, there is a wooden baby crib and tiny bed frame. yeah, I was back downstairs faster than you could say horror film :)
the area was beautiful, set back on this hillside surrounded by jungle. we hiked up until we found the cliché of all african villages, a futbol field on a crooked hill with a pile of rocks marking the two goal posts and a hodgepodge of children chasing after a miniature sized and semi-flat yellow soccer ball. we had no choice but to join in and all I can say is, the kids have got skillzzz!! we had a blast. every once in a while the ball would get kicked off the “field”, didn’t matter, they’d chase it down and keep playing (pretty much the only out of bounds was the clean laundry drying in one of the front yards). the cow feeding nearby ran interference on occasion and I think might have gotten more touches on the ball than me, but who’s counting ;) I was more about the congratulations high fives and the celebratory victory dance post goal (which the kids thought was really entertaining). aside from navigating the rugged terrain, you just had to be careful to enjoy the cow pies randomly distributed throughout the field. Good thing the kids we’re playing in…. oh wait, they were all playing in flip flops and a good number had kicked those off in the interest of speed. nothing says village soccer like cow poop between your toes. we played until we were flushed in the face and sweaty, then reluctantly said our goodbyes to our new friends (all probably about waist high and with footwork that would impress the pros). we headed for home shortly after, which entailed, not a motorbike ride down the mountain (too bad), but a coast in the oldest sedan still in running condition today. this thing had three rows of seats craftily fit into the tiny car and we had 12 people piled into a car meant to fit five, hakuna matata. we did not drive down the main road, no, we coasted down in neutral. I feared for my life probably only twice during the ride, and both times involved massive trucks coming the other direction. these are the moments we look at each other, say t.i.a., and laugh! creative family to come up with this fuel saving plan, and they’ve got the coasting to a science.
my favorite thing about arusha? the people. I’m sure you’ve picked up that we end up having random conversations pretty much on a daily basis. everyone is so friendly and it makes me want to change the way I treat strangers back in the states. Im usually all about striking up a conversation with anyone, but they take it to a whole different level here. example 1) old woman walks past us at the hospital today, she puts her arm around me, looks me straight in the eye (well, sort of, her left eye faced laterally, so she was technically only making eye contact with the right) and says something in swahili, I just return her toothless smile with a real big smile of my own and wait for andrew to translate (he’s been handy to have around as his swahili is really good from two years living in tanzania). “she says she loves you” and as he tell us this she is shaking all of our hands saying more things in swahili. I think I might love her too. example 2) we get our water in the hostel from a water cooler downstairs. the staff boil the water for us and we just fill our water bottles (and wait for it to cool… oh, and hope they’ve boiled it properly, which so far they haven’t let us down). anyway, sent amy and andrew down there to get some water today while thu and I napped (late night last night and early morning meant we got about 3 hours of sleep and we were desperately in need of nap time today). they came back up and along with our water delivered this message “vene says to tell you that god loves you” (vene is one of the women who works here). alright then! example 3) on our return trip from the hillside hospital today we were between coasting sedan and dala dala and this guy comes up to chat us on the road (typical) and he’s wearing one flip flop and one old black leather shoe without the laces and when andrew asks him about it he says he’s getting the other polished (this was most definitely his standard response to a question im sure he gets multiple times a day). anyway so he’s speaking to andrew in swahili and he’s pointing at me and andrew tells me he’s saying he loves me. so much love in this city. I hold up my left hand where I have a cheap, old ring strategically placed on my ring finger (word to all you single ladies out there, fake wedding ring in africa will save you! seriously, show the ring and you don’t have to say anything, the guys will leave you alone. amy thu and I have all found this very useful on countless occasions, particularly with, of all people, the creepy docs at the hospital who seem to really have a thing for thu - then again all the tanzanians seem to love thu the most)… this guy says something sounding a little disappointed, then lights up as he asks a question to andrew. I inquire as to what he said, andrew tells me “he wants to know if you have a younger sister”. t.i.a. and that’s how the tanzanian men work around here folks!
peaceful night with a few of the canadians who came back down to our beloved hostel for the weekend. live music at an open air restaurant, the guy was good too, really good, and he played for hours just a guitar and his incredible voice. I’m all about the stars here because there are lots, so I spent a good amount of time laying on the plush couch starring up at the southern cross (which I’ve seen for the first time in my life here, amazing!), and watching the stars move across the sky. the trees looked alive as the wind tousled the highest branches and huge bats swooped between the stars in search of dinner. it felt almost like home. it was a cool night and the sky looked a little unfamiliar without the big dipper, but the music was comforting and it felt like something I’d do during an oregon summer back home.
Friday, July 9, 2010
jambo portland, eh?
you better bet when germany played spain we were there cheering our hearts out for espana. then again, im not exactly sure why we chose spain over germany, but our crowd of travelers and locals overtook the loft seating at the empire bar (any place with a photo of tupac and bob marley on the wall is fine by me) and had a great time yelling down at all the people rooting for germany. one guy had the vuvuzela (sp?) from the world cup that he was obnoxiously blowing the entire game. by half time I would say about 95% of the bar was ready to break the thing over his head and the other 5% must have suffered hearing loss at some point in their life. so the second half rolls around and we’re all caught up in spain dominating the game (no offense germany fans) when we hear massive commotion downstairs. from our vantage point we see a serious fight break out over, of all things, the horn. this is not your run of the mill drunk guy trying to assert authority fight, this is an all out, punches being thrown and face contact made, fight. relieved we were safe in the loft, we all just peered down to see how things played out. about five guys were trying to hold back the one dude, another half a dozen were on the vuvuzela guy and everyone around was scattering to get away from the brawl. in the middle of the action the horn was dropped and one of the germany supporters snatched it up and hid it slyly behind his chair. we were thrilled. and even more excited when spain scored for the ultimate win. great game.
fitting seven in a small cab, not a problem here. since andrew’s been here and we’ve got deepaul and daaimah around, we are six and we’ve been like a little arusha family (we’ll adopt pretty much any hostel guest as well and sebastian is our latest member), making dinner, going out to dinner, watching world cup, and exploring the city more… except the more time we spend here the more you realize arusha is pretty small. we see our rafiki wearing a santa hat and riding his bike almost every morning. also, when we were walking to the hospital today I was telling andrew about the albino african we’ve seen and then she walked right past us! small town, eh? yes, we took andrew with us to the hospital, and yes, he started feeling woosy in the labor ward and had to leave. have I mentioned that spending so much time with laboring mothers just reinforces how much stronger women are than men :) no hard feelings all you boys out there but you go spend a week on the labor ward in arusha and there’s no way you’ll disagree.
labor ward was chaos as always (though nothing compared to monday), and we had a primi gravidae mom so reminiscent of monday’s woman that we are really stressing. worried we’d see a repeat of that situation, especially when the mother had again been laboring for so long and the nurse mentioned getting the resuscitation kit ready, we were on the nurses and docs like crazy making sure they were aware of the situation and doing what they could to help her. fortunately all went well (if you count the nurse performing a huge episiotomy and forcefully shoving the fetus from the mother’s stomach well), and the baby came out wailing. the mom might have named that baby happy. we’ve also had mothers named happy, or better than that, the ever-common happiness, gladness, joyness, or, get this, lightness. and today in the peds ward one of the boys was definitely named goodluck. they get real creative with the naming around here. on another upbeat note, since I’m sharing all of these uplifting names, we handed out a few scrub caps made by the wonderful michelle, one of the girls who traveled here last summer. the nurses love, LOVE, the scrub caps. well they love all gifts and half the time when we’re giving them donations I feel like we’re bribing them to like us, but every good doctor knows you have to do what it takes to keep your nurses happy and we’re definitely doing what we can to keep them happy. I think giving them the hand-sewn scrub caps will be a turning point in our relationship with the nurses. I even had one of the woman talk me through starting an IV today and it went well, I started my first IV!… think I’ve got the hang of it. speaking of learning new skills, dr. lace is finally here, a peds doc from salem, and he said we’d hopefully be learning how to perform BTL (bilateral tubal ligations) so that when we head out the villages we can help dr. temple (another doc from salem who comes here in late july) perform them under local for a bunch of the woman who are done with the whole childbirth business. I cannot wait!! more women around here need access to this form of contraception. we’ve been handing out more condoms, using them to bargain at the market which just cracks me up. the problem is we had this great idea to hand them out to the women but everyone we’ve talked to about this says it will be a waste because it is not the woman’s choice to use protection, which is why we need to hand them out the men and hope they’re complacent condom users. after what we saw last night at the via via bar/club we go to on thursdays, I hope that it is catching on here.
on a different note, finally tried legit local cuisine and I could not have been more into it. one of my favorite things about traveling is trying the local food and so far we hadn’t had much of the street food aside from chipati, which we all love. so we go to this little restaurant, only two tables and a few stools and food so unfamiliar I could not identify a single thing in the display case or on the menu. we got some ugali to split. ugali is maize flower and water and it’s made into this past that looks like mashed potatoes but it is harder than that, still soft but you can tear off pieces and dunk it in this steamed cabbage stuff and beans. you eat it all with your hands, even though it’s super messy. I felt like a little kid making such a mess and grabbing food (that was farrrr from finger food) with our hands. we also had this strange chick pea mush ball thing with maybe some green stuff mixed in, don’t remember what it was called but I liked it, and also chipati maji which was a lot like a crepe. finally this rice flour fried thing that was pretty much like tanzania’s version of a donut. such odd food but I was loving it!! not sure the girls were as into it as I was but, more for me, right? :) it got me really excited to try more of the local food.
headed off to visit the canadians in their hillside village today where they do hospital and dental stuff. it’ll be cool to see where they work, and fridays at the hospital are ridiculously dull so we let dr lace know and he didn’t seem to concerned. I’ll let you know how it goes, eh?
fitting seven in a small cab, not a problem here. since andrew’s been here and we’ve got deepaul and daaimah around, we are six and we’ve been like a little arusha family (we’ll adopt pretty much any hostel guest as well and sebastian is our latest member), making dinner, going out to dinner, watching world cup, and exploring the city more… except the more time we spend here the more you realize arusha is pretty small. we see our rafiki wearing a santa hat and riding his bike almost every morning. also, when we were walking to the hospital today I was telling andrew about the albino african we’ve seen and then she walked right past us! small town, eh? yes, we took andrew with us to the hospital, and yes, he started feeling woosy in the labor ward and had to leave. have I mentioned that spending so much time with laboring mothers just reinforces how much stronger women are than men :) no hard feelings all you boys out there but you go spend a week on the labor ward in arusha and there’s no way you’ll disagree.
labor ward was chaos as always (though nothing compared to monday), and we had a primi gravidae mom so reminiscent of monday’s woman that we are really stressing. worried we’d see a repeat of that situation, especially when the mother had again been laboring for so long and the nurse mentioned getting the resuscitation kit ready, we were on the nurses and docs like crazy making sure they were aware of the situation and doing what they could to help her. fortunately all went well (if you count the nurse performing a huge episiotomy and forcefully shoving the fetus from the mother’s stomach well), and the baby came out wailing. the mom might have named that baby happy. we’ve also had mothers named happy, or better than that, the ever-common happiness, gladness, joyness, or, get this, lightness. and today in the peds ward one of the boys was definitely named goodluck. they get real creative with the naming around here. on another upbeat note, since I’m sharing all of these uplifting names, we handed out a few scrub caps made by the wonderful michelle, one of the girls who traveled here last summer. the nurses love, LOVE, the scrub caps. well they love all gifts and half the time when we’re giving them donations I feel like we’re bribing them to like us, but every good doctor knows you have to do what it takes to keep your nurses happy and we’re definitely doing what we can to keep them happy. I think giving them the hand-sewn scrub caps will be a turning point in our relationship with the nurses. I even had one of the woman talk me through starting an IV today and it went well, I started my first IV!… think I’ve got the hang of it. speaking of learning new skills, dr. lace is finally here, a peds doc from salem, and he said we’d hopefully be learning how to perform BTL (bilateral tubal ligations) so that when we head out the villages we can help dr. temple (another doc from salem who comes here in late july) perform them under local for a bunch of the woman who are done with the whole childbirth business. I cannot wait!! more women around here need access to this form of contraception. we’ve been handing out more condoms, using them to bargain at the market which just cracks me up. the problem is we had this great idea to hand them out to the women but everyone we’ve talked to about this says it will be a waste because it is not the woman’s choice to use protection, which is why we need to hand them out the men and hope they’re complacent condom users. after what we saw last night at the via via bar/club we go to on thursdays, I hope that it is catching on here.
on a different note, finally tried legit local cuisine and I could not have been more into it. one of my favorite things about traveling is trying the local food and so far we hadn’t had much of the street food aside from chipati, which we all love. so we go to this little restaurant, only two tables and a few stools and food so unfamiliar I could not identify a single thing in the display case or on the menu. we got some ugali to split. ugali is maize flower and water and it’s made into this past that looks like mashed potatoes but it is harder than that, still soft but you can tear off pieces and dunk it in this steamed cabbage stuff and beans. you eat it all with your hands, even though it’s super messy. I felt like a little kid making such a mess and grabbing food (that was farrrr from finger food) with our hands. we also had this strange chick pea mush ball thing with maybe some green stuff mixed in, don’t remember what it was called but I liked it, and also chipati maji which was a lot like a crepe. finally this rice flour fried thing that was pretty much like tanzania’s version of a donut. such odd food but I was loving it!! not sure the girls were as into it as I was but, more for me, right? :) it got me really excited to try more of the local food.
headed off to visit the canadians in their hillside village today where they do hospital and dental stuff. it’ll be cool to see where they work, and fridays at the hospital are ridiculously dull so we let dr lace know and he didn’t seem to concerned. I’ll let you know how it goes, eh?
Wednesday, July 7, 2010
there are days and then there are days
warning: this is a sad one.
“It means a great deal to those who are oppressed to know that they are not alone. And never let anyone tell you that what you are doing is insignificant.”
- Bishop Desmond Tutu
if there was ever a day I needed some encouraging words, today would be it. thanks ma. we had a rough go of it at the hospital this morning. apparently the moms spend the weekend doing all they can to avoid pushing, then monday morning rolls around the flood gates open, literally. we walked into a labor ward packed with woman, every bed full and then some, waiting to be admitted, screaming with contractions, and actively delivering babies. you know those intense scenes in movies where there is utter chaos or some total disaster happening (think pearl harbor just after WWII starts) and everything slows down around that main character… it gets real quiet and slow motion so you can take in the pandemonium… I felt that this morning. I stood amidst the disorder and tried to figure out where to begin.
I’m watching a woman, primi gravidae, struggle to push with her contractions. she’s exhausting herself and the labor is not progressing. I see another woman walking down the hall next to thu, (moving to the area of the ward where she will deliver), stop, squat between the beds, and deliver her baby there on the floor. nurses are carrying newly delivered babies past me, there is a woman with a prolonged rupture of membranes who is not doing well. woman are screaming and it’s stressing me out, babies are crying and I’m relieved. I am trying to support amy as she helps the first woman. I glance back at a mother behind me who has just delivered and is now getting dressed. she is talking on her cell phone. she stands and pulls her skirt the rest of the way down. I turn back to amy and the struggling mother, no progress.
out of the corner of my eye I notice blood on the floor, fresh blood, drips accumulating and coagulating as my mind tries to piece together where it is coming from. then I realize the new mother, standing there talking on her phone, is bleeding, a lot. I can see the blood streaming down her ankles, it is spreading across her feet and turning the bottom of her skirt crimson. thu points and the woman looks down. seeing the blood she had not felt, she calmly hangs up the phone and begins to undress again, slowly, unconcerned with the clots of blood hitting the floor between her feet. we call for a nurse. the nurse comes quickly, glances at the woman, disregards the blood rapidly accumulating on the floor, and gives her a command in swahili. “she needs to pack more cotton”, the nurse says to us.
at mt meru regional hospital, each mother brings a roll of cotton with her when she comes to deliver (she is responsible for bringing other supplies as well – gloves, syringes, kanga’s to wrap the babies, you get the idea). post-delivery the women wad up the cotton and place it between their legs before they walk down to the post natal ward. imagine the very first pad or the original tampon, it is that archaic. but that cannot be the solution for this mother, there is too much blood. I’m staring wide eyed at the puddle thinking about when we learned to estimate blood loss in the labor and delivery elective I took at ohsu. more cotton was not the answer, that much I was sure.
i’m frozen as the nurse walks away. the woman is standing there, half naked, trying to clean the blood off her legs. her cell phone is ringing, it beeps the tune of jingle bells over and over. it is an eerie scene and I’m watching it as if from another place. watching the mother hemorrhage, watching her attempt to clean up blood she is losing all too quickly, watching the nurse get further and further away. I snap back. calling to the nurse as I follow her past more screaming, laboring mothers, I ask, “is it post-partum hemorrhage?” she looks at me puzzled. I try again. “is it PPH”, I say, distraught and frustrated. she looks at me and says no. I decide to be bold, risk offending a nurse (not something you want to do around here), “how do you know?” I ask timidly, trying not to sound threatening. “because I know.” she says, and walks away. great.
dr. ishmael arrives not long after. I am relieved, for the moment, and explain to him what has happened with this mother. he says yes, it is PPH. we get her started on fluids, no bother with a blood transfusion, but better than nothing. I check on her periodically throughout the rest of the day. as far as I know she does well. lucky. scary. surreal.
not so lucky is our primi gravidae (that’s what they write when it is the mother’s first pregnancy) mom who is still struggling to deliver. she can’t figure out how to push properly, she’s in excruciating pain, and there are so many other mother’s needing attention, she keeps getting passed over. amy and I explain the situation to dr. ishmael. he says it is bad because the baby is no longer in the amniotic fluid. we know this, we know it is bad, it is what we’ve been trying to tell the nurses! he does nothing to help. In fact, he walks away and we do not see him the rest of the day.
thu is at the other end of the ward, delivering more babies. they are coming so fast we are struggling to keep up. I walk between the beds, following the screams of mothers pleading for a nurse, help, anyone. I am checking each woman, looking for crowning heads. third mom I examine and the baby is almost there, she is contracting and pushing and looks up at me saying, “please pray for me”. I tell her I will, that it will be ok, that she’s doing great. I look around, no supplies, nothing prepared, and I’m alone. I yell for thu and fortunately she comes. i ask her to search for supplies. I have my gloves on in seconds and am doing what I can to help the mother, trying to prevent a tear. two contractions later and the baby’s head is in my hands, the membranes completely covering it’s face. I frantically peel them away from it’s mouth. sukuma!! the mom pushes again and the body comes spilling out. a big baby boy with a cry that almost brings tears to my eyes. thu shows up now, tells me there are no sterile supplies… wait, she sees the baby and moves on to the next laboring mother, never mind. I show the mother her beautiful baby, set him on her chest, say “good” and smile at her. she thanks me. eventually I clean her up, get her dressed, and walk her down with her healthy baby to the postnatal ward. carrying that perfect baby down there, him looking up at me, blinking, so warm in his blanket, it was peaceful. the first peace I’d felt all morning. but then I had to leave him with her and it was back to the mayhem.
our poor primi gravidae mother, she is still struggling. it’s been long, too long, an hour, two hours? what time is it? when did we get here? how long has she been laboring… what about the baby? stressful doesn’t do it justice: nerve-racking and we feel so helpless. that is the worst thing about it all. the nurse is finally there, amy is doing what she can to comfort the mother as the nurse takes over. I return in time to see a last desperate attempt from the nurse: episiotomy, and forceful pushing on the mother’s stomach as she pushes in desperation as well. it’s violent and awful and when the baby comes out it is blue and lifeless and I have to walk away. I’ve already had too much this morning, and there are so many other mothers in need of help. I am doing no good watching this futile effort to resuscitate the baby.
tragic. it is tragic because it could have been prevented. why didn’t they do the episiotomy earlier? it didn’t make sense to me. the nurses who had been checking on her from the beginning should have known, should have done something sooner. maybe the baby would have made it. instead there is a small corps wrapped in a kanga, only the toes sticking out, set under the scale where they weigh baby after baby born healthy and well on this day. that is the hardest thing we’ve dealt with thus far, obviously… a loss that seems all too preventable. the mourning mother was too much to watch. I felt like my heart had been ripped out. that physically pain in your chest that you can’t explain, like that place where your heart should be is actually hurting. you can’t comfort that. turn away and her forlorn cries still echoed throughout the labor ward. no one should have to experience loss like that. and to add to the pain, the nurse did a rough job of repairing her episiotomy. I felt my toes curl uncontrollably in my shoes as I watched her writhe in pain with each stitch of the enormous needle. I consciously told myself to relax, loosened my grip on the gloves wadded in my hands, breathed a little, and walked away. more mothers needed help.
“It means a great deal to those who are oppressed to know that they are not alone. And never let anyone tell you that what you are doing is insignificant.”
- Bishop Desmond Tutu
if there was ever a day I needed some encouraging words, today would be it. thanks ma. we had a rough go of it at the hospital this morning. apparently the moms spend the weekend doing all they can to avoid pushing, then monday morning rolls around the flood gates open, literally. we walked into a labor ward packed with woman, every bed full and then some, waiting to be admitted, screaming with contractions, and actively delivering babies. you know those intense scenes in movies where there is utter chaos or some total disaster happening (think pearl harbor just after WWII starts) and everything slows down around that main character… it gets real quiet and slow motion so you can take in the pandemonium… I felt that this morning. I stood amidst the disorder and tried to figure out where to begin.
I’m watching a woman, primi gravidae, struggle to push with her contractions. she’s exhausting herself and the labor is not progressing. I see another woman walking down the hall next to thu, (moving to the area of the ward where she will deliver), stop, squat between the beds, and deliver her baby there on the floor. nurses are carrying newly delivered babies past me, there is a woman with a prolonged rupture of membranes who is not doing well. woman are screaming and it’s stressing me out, babies are crying and I’m relieved. I am trying to support amy as she helps the first woman. I glance back at a mother behind me who has just delivered and is now getting dressed. she is talking on her cell phone. she stands and pulls her skirt the rest of the way down. I turn back to amy and the struggling mother, no progress.
out of the corner of my eye I notice blood on the floor, fresh blood, drips accumulating and coagulating as my mind tries to piece together where it is coming from. then I realize the new mother, standing there talking on her phone, is bleeding, a lot. I can see the blood streaming down her ankles, it is spreading across her feet and turning the bottom of her skirt crimson. thu points and the woman looks down. seeing the blood she had not felt, she calmly hangs up the phone and begins to undress again, slowly, unconcerned with the clots of blood hitting the floor between her feet. we call for a nurse. the nurse comes quickly, glances at the woman, disregards the blood rapidly accumulating on the floor, and gives her a command in swahili. “she needs to pack more cotton”, the nurse says to us.
at mt meru regional hospital, each mother brings a roll of cotton with her when she comes to deliver (she is responsible for bringing other supplies as well – gloves, syringes, kanga’s to wrap the babies, you get the idea). post-delivery the women wad up the cotton and place it between their legs before they walk down to the post natal ward. imagine the very first pad or the original tampon, it is that archaic. but that cannot be the solution for this mother, there is too much blood. I’m staring wide eyed at the puddle thinking about when we learned to estimate blood loss in the labor and delivery elective I took at ohsu. more cotton was not the answer, that much I was sure.
i’m frozen as the nurse walks away. the woman is standing there, half naked, trying to clean the blood off her legs. her cell phone is ringing, it beeps the tune of jingle bells over and over. it is an eerie scene and I’m watching it as if from another place. watching the mother hemorrhage, watching her attempt to clean up blood she is losing all too quickly, watching the nurse get further and further away. I snap back. calling to the nurse as I follow her past more screaming, laboring mothers, I ask, “is it post-partum hemorrhage?” she looks at me puzzled. I try again. “is it PPH”, I say, distraught and frustrated. she looks at me and says no. I decide to be bold, risk offending a nurse (not something you want to do around here), “how do you know?” I ask timidly, trying not to sound threatening. “because I know.” she says, and walks away. great.
dr. ishmael arrives not long after. I am relieved, for the moment, and explain to him what has happened with this mother. he says yes, it is PPH. we get her started on fluids, no bother with a blood transfusion, but better than nothing. I check on her periodically throughout the rest of the day. as far as I know she does well. lucky. scary. surreal.
not so lucky is our primi gravidae (that’s what they write when it is the mother’s first pregnancy) mom who is still struggling to deliver. she can’t figure out how to push properly, she’s in excruciating pain, and there are so many other mother’s needing attention, she keeps getting passed over. amy and I explain the situation to dr. ishmael. he says it is bad because the baby is no longer in the amniotic fluid. we know this, we know it is bad, it is what we’ve been trying to tell the nurses! he does nothing to help. In fact, he walks away and we do not see him the rest of the day.
thu is at the other end of the ward, delivering more babies. they are coming so fast we are struggling to keep up. I walk between the beds, following the screams of mothers pleading for a nurse, help, anyone. I am checking each woman, looking for crowning heads. third mom I examine and the baby is almost there, she is contracting and pushing and looks up at me saying, “please pray for me”. I tell her I will, that it will be ok, that she’s doing great. I look around, no supplies, nothing prepared, and I’m alone. I yell for thu and fortunately she comes. i ask her to search for supplies. I have my gloves on in seconds and am doing what I can to help the mother, trying to prevent a tear. two contractions later and the baby’s head is in my hands, the membranes completely covering it’s face. I frantically peel them away from it’s mouth. sukuma!! the mom pushes again and the body comes spilling out. a big baby boy with a cry that almost brings tears to my eyes. thu shows up now, tells me there are no sterile supplies… wait, she sees the baby and moves on to the next laboring mother, never mind. I show the mother her beautiful baby, set him on her chest, say “good” and smile at her. she thanks me. eventually I clean her up, get her dressed, and walk her down with her healthy baby to the postnatal ward. carrying that perfect baby down there, him looking up at me, blinking, so warm in his blanket, it was peaceful. the first peace I’d felt all morning. but then I had to leave him with her and it was back to the mayhem.
our poor primi gravidae mother, she is still struggling. it’s been long, too long, an hour, two hours? what time is it? when did we get here? how long has she been laboring… what about the baby? stressful doesn’t do it justice: nerve-racking and we feel so helpless. that is the worst thing about it all. the nurse is finally there, amy is doing what she can to comfort the mother as the nurse takes over. I return in time to see a last desperate attempt from the nurse: episiotomy, and forceful pushing on the mother’s stomach as she pushes in desperation as well. it’s violent and awful and when the baby comes out it is blue and lifeless and I have to walk away. I’ve already had too much this morning, and there are so many other mothers in need of help. I am doing no good watching this futile effort to resuscitate the baby.
tragic. it is tragic because it could have been prevented. why didn’t they do the episiotomy earlier? it didn’t make sense to me. the nurses who had been checking on her from the beginning should have known, should have done something sooner. maybe the baby would have made it. instead there is a small corps wrapped in a kanga, only the toes sticking out, set under the scale where they weigh baby after baby born healthy and well on this day. that is the hardest thing we’ve dealt with thus far, obviously… a loss that seems all too preventable. the mourning mother was too much to watch. I felt like my heart had been ripped out. that physically pain in your chest that you can’t explain, like that place where your heart should be is actually hurting. you can’t comfort that. turn away and her forlorn cries still echoed throughout the labor ward. no one should have to experience loss like that. and to add to the pain, the nurse did a rough job of repairing her episiotomy. I felt my toes curl uncontrollably in my shoes as I watched her writhe in pain with each stitch of the enormous needle. I consciously told myself to relax, loosened my grip on the gloves wadded in my hands, breathed a little, and walked away. more mothers needed help.
there is no blood
it is july 6th, and i was joined by a young(-ish) boy on our walk to work today. he chatted with me pretty much the entire way while thu and amy followed behind listening. his english was decent but I spoke simply to limit the miscommunications (I feel my english may suffer during my travels). this is not a rare occurrence, making friends with strangers here is a daily happening. in fact, when thu and I went for a run today I definitely ended up racing a local... you heard me right :) he ran past us originally then walked ahead, so I ran up past him and as I went by he broke into a sprint. obviously an invitation to race - we sprinted down the road side by side, I was laughing, he kicked my butt. he slowed up ahead and I ran up next to him and told him “you’re fast”. we sprinted on and off a little after that, then I’d circle back to find thu. games with locals. what we’re really wanting to do is challenge the kids here to a pickup futbol match on the field we run by each day. wait for it, it’ll happen.
the hospital wasn’t nearly as fun as meeting locals. but it was shocking as ever… I got to be in the operating theater today. another experience worth writing about, but difficult to witness. I wheeled the woman, in need of a c-section, to the operating theater, literally on the opposite side of the hospital (convenient, right?). she was blowing air between her lips, making that motor boat noise continuously as we went. I was a little confused about whether or not they’d given her meds yet, I thought no, but her behavior was strange. anyway, we arrive and time passes and she sits quietly, waiting, her IV drip is causing her arm to swell because it is not properly in a vessel and her foley catheter bag is sitting on the floor between her feet. not sure what the cue to begin was, but they eventually asked her to walk into the theater and climb herself onto the table. this among the contractions she’d been suffering though as she was waiting. oh, and yes, they take all of her clothes from her first so she is literally naked on this bare table in a big room with a handful of people bustling around her.
she sits there shivering in the cold room, goosebumps cover her body. the nurse comes to sterilize her back, sort of. I cannot get past the inconsistencies and faults when it comes to sterile technique here. the anesthesiologist calls me over, wraps her hands around the lower back of the woman and says, iliac crest, as she emphasizes where her fingers sit. her thumbs come together at the spine, she digs one of her finger nails in, leaving a mark. quickly retrieving a long needle and syringe, she turns and stabs it deep into the woman’s back over the mark she has made. after pulling it out, readjusting the angle and reinserting it deep between the vertebral spines, cerebral spinal fluid begins to drip from the end. next she injects whatever outdated drug they’re using for the epidural. at least this woman gets an epidural. when thu watched the procedure they had trouble accessing the CSF space and gave up – voila! cesarean section without meds. any takers?
the doc comes in, wearing ohsu scrubs no less, and the mask he had requested from me earlier, inside out (? I know). the staff here want everything you have. they will ask for your masks, your gloves, and above all, your pens. as I’ve mentioned before we carry a handful of pens on us each day and without fail they are gone by the time we leave. he waits hardly a moment after the epidural has been given. two drapes and the patient is ready to go, wide awake and still shivering in the cold room. he slices from a.s.i.s. to a.s.i.s. (anterior superior iliac spine aka her hip bones) and her skin spits revealing a thin layer of yellow fat and then fascia. he cuts though that as well, tears through it more so, cuts the muscle and at this point a few of the woman are standing next to me observing and they keep repeating “there is no blood”. that’s debatable, I mean, there was some blood, but apparently not what they were expecting. the anesthesiologist brings out the blood pressure cuff and an ancient looking sphygmomanometer, er, the part with the pressure on it, not sure what it’s called alone, but it is wheeled out and attached to the cuff and it looks like a huge thermometer with some liquid that rises inside as she pumps up the cuff. our mama to be is hypotensive. they increase the rate with which they are giving fluids and begin to bag her. for a moment I’m worried this is going to get very bad very fast, but the surgeon is cutting deeper and now her shiny uterus is distracting me. he cuts through the superficial layer and then blunt dissects through the rest. once they’re in, he grabs one side of the hole he’s made, the nurse grabs the other, and they literally throw their body weight apart, yanking violently on all her tissue layers, attempting to widen the gap enough for a baby to fit through. the hole is not big but he gets his hand inside and somehow retrieves the baby’s head, which barely squeezes through. it is reminiscent of an SVD. the body is next. the baby’s cord is swiftly clamped and cut before she’s whisked away to be weighed and given an APGAR score. I glance back and the woman’s uterus is sitting atop her stomach, pulled out of the incision for the repair. it is large and thick with muscle after 9 months carrying a fetus. wild. the surgeon makes quick work of repairing the damage he inflicted, and then stuffs the huge, circular organ back inside the abdomen, like santa stuffing presents into his red velvet bag. yes, that is what it reminded me of. he finished closing. the whole thing was impressively efficient and I stayed to watch the next.
aside from a few of the more blaring instances of disregard for patient comfort, this was probably one of the most humane and potentially sterile-ish procedures I’ve seen here. the patient was not in excruciating pain, (though for the second woman I think her meds might have been wearing off by the end because she began to clench my hand tightly with the more aggressive maneuvers of the surgeon), and there was no yelling or slapping of the mothers (as I’ve heard will happen with the woman are “uncooperative”), and a sterile field was somewhat maintained considering the resources they’re working with.
I know so many of my stories have seemed jaw-dropping unbelievable, and we’ve been struggling to deal with the way things work around here, but it is not a bad place. they work with what they have, which is not a lot, and they do the best they can considering the differences in education and the expectations/standards of society as a whole. they simply do not have the means to wait by each woman’s bed holding her hand until she is finally ready to deliver. they must cater to the other mothers and wait until that crowning head appears before they turn their attention to that particular woman. we will help where we can, distribute what supplies we have brought with us, and educate when possible about some of the more evident places where they could easily improve (sterile technique in general, vaginal exams, proper suctioning of the babies’ mouths after delivery, etc). that said, many of this issues are here in the first place due to a lack of financial stability and government support. this is a government run hospital after all and it has nothing. we’re constantly running out of sterile supplies and if I told you how we sterilize the supplies here you wouldn’t believe me. I watched a nurse today perform an episiotomy on a patient using rusted and dull scissors that could hardly cut through the baby’s cord once he was born.but what do you do? where do you begin? the supplies we are donating will only go so far. our suggestions and teachings might only reach one or two nurses, and maybe only for that day. and then, surprise surprise, we’re back to feeling powerless. however, despite feeling helpless amidst all of these adversities, we can, at the very least, be helpful. and so we deliver babies and admit mothers and support patients, or we do the less glamorous tasks (not that I’d call delivering babies glamorous, but definitely gratifying), like fetching clean sheets or wrapping supplies to be autoclaved. we are here to help where we can and that is what we’ve been doing, or at least trying to do.
the hospital wasn’t nearly as fun as meeting locals. but it was shocking as ever… I got to be in the operating theater today. another experience worth writing about, but difficult to witness. I wheeled the woman, in need of a c-section, to the operating theater, literally on the opposite side of the hospital (convenient, right?). she was blowing air between her lips, making that motor boat noise continuously as we went. I was a little confused about whether or not they’d given her meds yet, I thought no, but her behavior was strange. anyway, we arrive and time passes and she sits quietly, waiting, her IV drip is causing her arm to swell because it is not properly in a vessel and her foley catheter bag is sitting on the floor between her feet. not sure what the cue to begin was, but they eventually asked her to walk into the theater and climb herself onto the table. this among the contractions she’d been suffering though as she was waiting. oh, and yes, they take all of her clothes from her first so she is literally naked on this bare table in a big room with a handful of people bustling around her.
she sits there shivering in the cold room, goosebumps cover her body. the nurse comes to sterilize her back, sort of. I cannot get past the inconsistencies and faults when it comes to sterile technique here. the anesthesiologist calls me over, wraps her hands around the lower back of the woman and says, iliac crest, as she emphasizes where her fingers sit. her thumbs come together at the spine, she digs one of her finger nails in, leaving a mark. quickly retrieving a long needle and syringe, she turns and stabs it deep into the woman’s back over the mark she has made. after pulling it out, readjusting the angle and reinserting it deep between the vertebral spines, cerebral spinal fluid begins to drip from the end. next she injects whatever outdated drug they’re using for the epidural. at least this woman gets an epidural. when thu watched the procedure they had trouble accessing the CSF space and gave up – voila! cesarean section without meds. any takers?
the doc comes in, wearing ohsu scrubs no less, and the mask he had requested from me earlier, inside out (? I know). the staff here want everything you have. they will ask for your masks, your gloves, and above all, your pens. as I’ve mentioned before we carry a handful of pens on us each day and without fail they are gone by the time we leave. he waits hardly a moment after the epidural has been given. two drapes and the patient is ready to go, wide awake and still shivering in the cold room. he slices from a.s.i.s. to a.s.i.s. (anterior superior iliac spine aka her hip bones) and her skin spits revealing a thin layer of yellow fat and then fascia. he cuts though that as well, tears through it more so, cuts the muscle and at this point a few of the woman are standing next to me observing and they keep repeating “there is no blood”. that’s debatable, I mean, there was some blood, but apparently not what they were expecting. the anesthesiologist brings out the blood pressure cuff and an ancient looking sphygmomanometer, er, the part with the pressure on it, not sure what it’s called alone, but it is wheeled out and attached to the cuff and it looks like a huge thermometer with some liquid that rises inside as she pumps up the cuff. our mama to be is hypotensive. they increase the rate with which they are giving fluids and begin to bag her. for a moment I’m worried this is going to get very bad very fast, but the surgeon is cutting deeper and now her shiny uterus is distracting me. he cuts through the superficial layer and then blunt dissects through the rest. once they’re in, he grabs one side of the hole he’s made, the nurse grabs the other, and they literally throw their body weight apart, yanking violently on all her tissue layers, attempting to widen the gap enough for a baby to fit through. the hole is not big but he gets his hand inside and somehow retrieves the baby’s head, which barely squeezes through. it is reminiscent of an SVD. the body is next. the baby’s cord is swiftly clamped and cut before she’s whisked away to be weighed and given an APGAR score. I glance back and the woman’s uterus is sitting atop her stomach, pulled out of the incision for the repair. it is large and thick with muscle after 9 months carrying a fetus. wild. the surgeon makes quick work of repairing the damage he inflicted, and then stuffs the huge, circular organ back inside the abdomen, like santa stuffing presents into his red velvet bag. yes, that is what it reminded me of. he finished closing. the whole thing was impressively efficient and I stayed to watch the next.
aside from a few of the more blaring instances of disregard for patient comfort, this was probably one of the most humane and potentially sterile-ish procedures I’ve seen here. the patient was not in excruciating pain, (though for the second woman I think her meds might have been wearing off by the end because she began to clench my hand tightly with the more aggressive maneuvers of the surgeon), and there was no yelling or slapping of the mothers (as I’ve heard will happen with the woman are “uncooperative”), and a sterile field was somewhat maintained considering the resources they’re working with.
I know so many of my stories have seemed jaw-dropping unbelievable, and we’ve been struggling to deal with the way things work around here, but it is not a bad place. they work with what they have, which is not a lot, and they do the best they can considering the differences in education and the expectations/standards of society as a whole. they simply do not have the means to wait by each woman’s bed holding her hand until she is finally ready to deliver. they must cater to the other mothers and wait until that crowning head appears before they turn their attention to that particular woman. we will help where we can, distribute what supplies we have brought with us, and educate when possible about some of the more evident places where they could easily improve (sterile technique in general, vaginal exams, proper suctioning of the babies’ mouths after delivery, etc). that said, many of this issues are here in the first place due to a lack of financial stability and government support. this is a government run hospital after all and it has nothing. we’re constantly running out of sterile supplies and if I told you how we sterilize the supplies here you wouldn’t believe me. I watched a nurse today perform an episiotomy on a patient using rusted and dull scissors that could hardly cut through the baby’s cord once he was born.but what do you do? where do you begin? the supplies we are donating will only go so far. our suggestions and teachings might only reach one or two nurses, and maybe only for that day. and then, surprise surprise, we’re back to feeling powerless. however, despite feeling helpless amidst all of these adversities, we can, at the very least, be helpful. and so we deliver babies and admit mothers and support patients, or we do the less glamorous tasks (not that I’d call delivering babies glamorous, but definitely gratifying), like fetching clean sheets or wrapping supplies to be autoclaved. we are here to help where we can and that is what we’ve been doing, or at least trying to do.
Monday, July 5, 2010
happy birthday america!
no really, fourth of july without fireworks is like christmas without presents. hope you’re all having a wonderful time celebrating, because I haven’t heard or seen a firework all day, and it’d be a little depressing had we not spend the day on an incredible adventure to mt. kilimanjaro. you know that saying, something about, it’s not the destination, but the journey that counts… I think I got the meaning of that today. we woke up early, hoping to catch breakfast before the 20 plus 16-18 year olds who are here on a mission trip and staying at the hostel, no luck. I now know what it feels like to be a part of a large family, where the last piece of bread can literally be snatched from beneath your outstretched hand, and the butter is gone by the time it’s passed to your end of the table. we’ll be glad to have them leave today. the past two days they’ve been up before six noisily chatting away as they wait in line for one of the two shower stalls. we’re up at six all week, we were hoping to get to sleep in this weekend… I suppose there’s always next weekend.
a couple hours later and I’m sitting on a bus. I lucked out with the window seat. thu is next to me and the lady sitting beside her looks like she might vomit at any moment. I don’t blame her, the bus is packed. I counted 24 seats and 36 people. doesn’t quite add up… at the time I thought we were doing a pretty decent job of exceeding max capacity, but africans have an impressive ability to fit in small, cramped spaces, and so as we drove, we periodically stopped to take on more passengers bound for moshi. crowded - the bus was very crowded and I was glad to have my window.
in front of me sat anthony, an ortho nurse from australia, 10 years traveling and working, and after this trip (he’s been here at a maternity hospital for the past four months) he plans to head back to australia to open a skate shop – his true passion. on either side of him, two younger girls, both from england I believe, claire and I don’t remember the other’s name, but they had scabbing on their shoulders that I kept trying to examine, until, unable to explain the round burns, I asked brian, a texan born in jersey and here doing service work. brian, who fortunately had decided to carry a large american flag with him on this day (our only celebration of the fourth here was taking photos with the flag), said they were burns from a maasai village. apparently the maasai people have figured out how to brand tourists, and they do so with scalding metal in the shape of a circle that they use to decorate the arms and legs of any willing traveler. no thanks. the burns were deep, I examined claire’s when she was asleep on the bus next to me… those scars will be with her a while, if not for her whole life.
brian’s friend tiffany was also along with their program (I can’t remember the name of it, but it recruits people from around the world to come do service work in schools and orphanages). I watched today as she wandered obliviously across the street (you never wander obliviously across the street in tanzania unless you have a death wish), sucking on a juice box, only to the look up just as a bus slammed on it’s breaks, stopping about a foot from her face (for once I am not exaggerating, there was a moment where I saw her getting plowed over like that scene from mean girls). she is from jersey, and from the time that I knew her today, the definition of ordinary (aside from the whole bus incident). graziana was far more interesting to me. born in poland but living in england now, her accent was adorable and she is the one who had arranged our guide for the day (more on that later). she sat in the back of the bus with eli, a canadian who I thought looked remarkably like scarlet johansen, and who really never stopped talking (this coming from a girl who rarely shuts up, you know she must’ve been a chatter box :) I can tell you the date of her parent’s anniversary, their ages, how they met… I know stories of her grandmother, who she married, where she lived, how many kids she had… I know her favorite sport to watch, who she watches it with and what type of beer she’s drinks during… I know who will be picking her up from the airport and why her parents won’t be there when she arrives… get the idea? it was so extreme that I’d call it comical. in contrast, lenny was a dark, quiet guy from the UK, who decided to sit in the front of the dalla dalla (tanzania’s version of the filipino jeepney) next to the driver when we all sat in the back. because he never really talked, I didn’t learn much about him. evan though, I know lots about… for one, his name pretty much says it all (no offense to any evan’s out there ;). imagine the male version on eli. between the two them there was never, ever a lull in conversation.
these were my travel companions for the day. by a stroke of luck we missed the street to the bus station this morning. just as we were starting to look lost (something you never want to do in arusha) a group of mzungu’s (white people) approached from the other direction. it didn’t take long to figure out they were english speakers and headed to moshi as well. we tagged along with their group to the bus station, and the rest of the day for that matter. we had left the hostel this morning with absolutely no plan beyond wanting to see kilimanjaro. having been warned it’s a bit dangerous to travel so far (about three hours of travel each way), just us three girls, we were happy to be adopted by this diverse group of nine.
back on the bus. I’m taking in everything. I’ve got my headphones in and I’m listening to phoenix. the songs are a perfect soundtrack to the movie playing out my window. I smell car exhaust, so thick I can feel my lungs turning black, or at least my boogers turning brown :) the sun is beating in my window. brain has the flag hanging over the window behind me, blocking the sun, calling more attention to us, as if we need it. cow. locals staring and I’m staring back, smiling. I wave at a little kid who frantically returns the gesture. we’re picking up speed and the cars coming the other way are so close I can’t help but blink as they whiz by. even when I’m expecting it, blink! so close to my face. please keeps your arms, and especially heads, inside the window at all times. the dust kicks up and I prefer how it smells to the gasoline. old woman roasting cord beside the road. a man walks his goat. another cow, the rope tethering it to a patch of grass is tied through it’s large nostrils. fruit and vegetable stands – buckets of tomatoes and potatoes and oranges (though I don’t know why they call them that here, they should be called yellow and greens because that’s the color of them, not orange). pile of trash. blink! a bus passes us, far too close. I smell the diesel again, now we’re passing a car. I’ve never felt so nervous driving in what I know to be the correct lane. I still get confused about crossing the street, right then left, right then left! obama poster on a truck. pile of burning trash- probably the closest we’ll come to fireworks here. a maasai man on his bike, his herding stick over his shoulder. the reds and purples of the fabrics he wears are billowing in the wind behind him. usher poster on a dalla dalla. lots of corn fields but the problem is they look very much dead. there are sunflowers too, huge and towering over the dead corn fields. dry river beds. that might explain the dead corn. a woman herds two donkeys, the three of them are weighed down with colorful buckets of water. we go in and out of the shadows of the clouds. I smell the distinctive body odor of the people here. it doesn’t matter if I’m leaning down to talk with a six year old girl, if I’m walking through the labor ward, or if I’m following our guide for the day too close, everyone smells the same and it is the kind of smell that makes me want to hold my breath. people back home stink too, but this is a different stink, a characteristic smell new to my nose.
finally the landscape opens up and I can see distant hills, but the clouds are thicker up ahead and there’s no sign of kilimanjaro. I try not to be disappointed… yet. the cloud shadows speckle the plains and a dust devil spins angrily not far from the road. I’ve got the obs/gyn book I brought open on my lap. I read it for the first ten or fifteen minutes of the trip, trying to review, but then we left our familiar town and I got distracted with the new countryside. the rhythmic bouncing of the bus has put thu to sleep. half finished houses whiz by, made of brick with no windows or roof. the cell phone company logos are everywhere, and any sign for a business or restaurant has the same girl drinking coco cola on it. car accident. It temporarily slows traffic, just as in the US, only there is no fire truck, no ambulance, only a tow truck loading the mutilated frame of the tiny car. I remember what thu said about this being a very dangerous road. I can see why. it is narrow and the cars go too fast. we pull off the road periodically to let a passenger or two go and pick up a handful more. cars honk as they pass. when the bus stops boys walk up to the windows trying to sell candy, cookies, or eggs.
“hapana asante, rafiki!” I have found this sentence to be the most useful way to get them to leave you alone. that, or to get asked on a date. we’ve been on the bus for almost an hour now. I can hear the radio of the bus over my music, ranting about something. a woman sits by the road sewing on an ancient machine. we pass a tree so large ten people couldn’t wrap their arms around the trunk. I can’t remember how long ago I saw the sign that said 52 km to moshi. my window is on the right side of the bus. when kilimanjaro appears, above the clouds and perfectly snow capped, it is to our left. I crane my neck to get a glimpse. anthony says he’s been here four months and it’s the first he’s seen the mountain. we were hoping for a better view, because when we left arusha there wasn’t a cloud in the sky. graziana has taken the bus to moshi already twice in hopes of seeing kili and has had no luck. today she is thrilled. and by the time we are busing back to arusha, as the sun is setting, the clouds are gone altogether and we get an incredible view of the tallest mountain on this continent. I want to climb it. another time, another trip. for now I’m going to focus on mt. meru. they say it’s harder to climb than kili but you can do it in fewer days. the sun was just dipping below the horizon as we drove past meru on our home. It was just as magnificent as kili in my opinion. crossing my fingers that climb works out.
we are an hour+ bus ride, then another hour+ dalla dalla ride from arusha to the jungle around kilimanjaro. we are hiking, our group of 12, led by a guide who stops periodically to rattle of trivial facts, some of which I’m quite certain he makes up. the kids come out from their huts and brick homes to follow us, beckoning our attention with little “jambo’s” and “mambo’s” and raised hands in hopes of reciprocated high fives. I high five every kid, don’t want anyone to feel left out. our guide picks up a chameleon with a stick. I’m very excited, never seen a chameleon in real life before! photos to come :)
the hike to the waterfall is a mini version of our first waterfall hike. lots of down. the thing about waterfalls is that they require large cliffs for the water to fall over, and deep valleys for it to fall into. to see waterfalls from below, you must hike into those deep valleys. rocket science, I know. they provided us with walking sticks. what a relief! the neatly carved stairs and sturdy railing were obviously not enough… catching the sarcasm yet? this is a tourist trap! carved walking sticks for each person in the group, really?! good thing we had connections and the whole thing ended up costing us about $6 each for all of the transportation, the guide, the rented walking sticks (?), everything. awesome. the waterfall was well worth tolerating gerber feeding during the hike. though not as tall as our first waterfall, it was still enormous and much wider. with the sun out, the beams were shimmering in the mist. shimmering is a cool word. shoes were off and everyone was wading around, climbing rocks, taking pictures, enjoying the refreshing mist. our guide would literally toss you over his shoulder and carry you from rock to rock if you didn’t want to get wet. again, we find ourselves in the middle of a jungle, in the middle of nowhere tanzania, (somewhere near kili, I know that much), and this time on the fourth of july. put a sparkler in my hand at that moment and I couldn’t have asked for anything more.
on the way back, and I don’t know how this happened in the half an hour or so we spent at the waterfall, a nest of fire ants was disturbed and the little guys were having a frenzy on the trail. the creepy thing about them is that you can hear them before you see them. creepy, or maybe fortunate, it serves as a good warning. just thinking about them makes me shiver. they are large and black and fast and hissing and have a bite to match how menacing they look. I contemplated staying down there at the waterfall until the trail cleared up because the only way to get past them, all running frantically in different directions, was basically to step right in the center of the swarm real fast then once you’re past, stomp a lot and hope they come off before biting. no thank you. Ill just hang out here until they leave. africa is not a place to hate bugs, if I could help it I would. I got past but don’t doubt there was some squealing involved.
all in all a great adventure – seems to be the theme of arusha. work week starts tomo and my friend andrew will be on a bus here by midweek to visit for a few days. he is a peace corps volunteer in southern tanzania. should be fun to have a semi-local around. happy fourth everyone!!
a couple hours later and I’m sitting on a bus. I lucked out with the window seat. thu is next to me and the lady sitting beside her looks like she might vomit at any moment. I don’t blame her, the bus is packed. I counted 24 seats and 36 people. doesn’t quite add up… at the time I thought we were doing a pretty decent job of exceeding max capacity, but africans have an impressive ability to fit in small, cramped spaces, and so as we drove, we periodically stopped to take on more passengers bound for moshi. crowded - the bus was very crowded and I was glad to have my window.
in front of me sat anthony, an ortho nurse from australia, 10 years traveling and working, and after this trip (he’s been here at a maternity hospital for the past four months) he plans to head back to australia to open a skate shop – his true passion. on either side of him, two younger girls, both from england I believe, claire and I don’t remember the other’s name, but they had scabbing on their shoulders that I kept trying to examine, until, unable to explain the round burns, I asked brian, a texan born in jersey and here doing service work. brian, who fortunately had decided to carry a large american flag with him on this day (our only celebration of the fourth here was taking photos with the flag), said they were burns from a maasai village. apparently the maasai people have figured out how to brand tourists, and they do so with scalding metal in the shape of a circle that they use to decorate the arms and legs of any willing traveler. no thanks. the burns were deep, I examined claire’s when she was asleep on the bus next to me… those scars will be with her a while, if not for her whole life.
brian’s friend tiffany was also along with their program (I can’t remember the name of it, but it recruits people from around the world to come do service work in schools and orphanages). I watched today as she wandered obliviously across the street (you never wander obliviously across the street in tanzania unless you have a death wish), sucking on a juice box, only to the look up just as a bus slammed on it’s breaks, stopping about a foot from her face (for once I am not exaggerating, there was a moment where I saw her getting plowed over like that scene from mean girls). she is from jersey, and from the time that I knew her today, the definition of ordinary (aside from the whole bus incident). graziana was far more interesting to me. born in poland but living in england now, her accent was adorable and she is the one who had arranged our guide for the day (more on that later). she sat in the back of the bus with eli, a canadian who I thought looked remarkably like scarlet johansen, and who really never stopped talking (this coming from a girl who rarely shuts up, you know she must’ve been a chatter box :) I can tell you the date of her parent’s anniversary, their ages, how they met… I know stories of her grandmother, who she married, where she lived, how many kids she had… I know her favorite sport to watch, who she watches it with and what type of beer she’s drinks during… I know who will be picking her up from the airport and why her parents won’t be there when she arrives… get the idea? it was so extreme that I’d call it comical. in contrast, lenny was a dark, quiet guy from the UK, who decided to sit in the front of the dalla dalla (tanzania’s version of the filipino jeepney) next to the driver when we all sat in the back. because he never really talked, I didn’t learn much about him. evan though, I know lots about… for one, his name pretty much says it all (no offense to any evan’s out there ;). imagine the male version on eli. between the two them there was never, ever a lull in conversation.
these were my travel companions for the day. by a stroke of luck we missed the street to the bus station this morning. just as we were starting to look lost (something you never want to do in arusha) a group of mzungu’s (white people) approached from the other direction. it didn’t take long to figure out they were english speakers and headed to moshi as well. we tagged along with their group to the bus station, and the rest of the day for that matter. we had left the hostel this morning with absolutely no plan beyond wanting to see kilimanjaro. having been warned it’s a bit dangerous to travel so far (about three hours of travel each way), just us three girls, we were happy to be adopted by this diverse group of nine.
back on the bus. I’m taking in everything. I’ve got my headphones in and I’m listening to phoenix. the songs are a perfect soundtrack to the movie playing out my window. I smell car exhaust, so thick I can feel my lungs turning black, or at least my boogers turning brown :) the sun is beating in my window. brain has the flag hanging over the window behind me, blocking the sun, calling more attention to us, as if we need it. cow. locals staring and I’m staring back, smiling. I wave at a little kid who frantically returns the gesture. we’re picking up speed and the cars coming the other way are so close I can’t help but blink as they whiz by. even when I’m expecting it, blink! so close to my face. please keeps your arms, and especially heads, inside the window at all times. the dust kicks up and I prefer how it smells to the gasoline. old woman roasting cord beside the road. a man walks his goat. another cow, the rope tethering it to a patch of grass is tied through it’s large nostrils. fruit and vegetable stands – buckets of tomatoes and potatoes and oranges (though I don’t know why they call them that here, they should be called yellow and greens because that’s the color of them, not orange). pile of trash. blink! a bus passes us, far too close. I smell the diesel again, now we’re passing a car. I’ve never felt so nervous driving in what I know to be the correct lane. I still get confused about crossing the street, right then left, right then left! obama poster on a truck. pile of burning trash- probably the closest we’ll come to fireworks here. a maasai man on his bike, his herding stick over his shoulder. the reds and purples of the fabrics he wears are billowing in the wind behind him. usher poster on a dalla dalla. lots of corn fields but the problem is they look very much dead. there are sunflowers too, huge and towering over the dead corn fields. dry river beds. that might explain the dead corn. a woman herds two donkeys, the three of them are weighed down with colorful buckets of water. we go in and out of the shadows of the clouds. I smell the distinctive body odor of the people here. it doesn’t matter if I’m leaning down to talk with a six year old girl, if I’m walking through the labor ward, or if I’m following our guide for the day too close, everyone smells the same and it is the kind of smell that makes me want to hold my breath. people back home stink too, but this is a different stink, a characteristic smell new to my nose.
finally the landscape opens up and I can see distant hills, but the clouds are thicker up ahead and there’s no sign of kilimanjaro. I try not to be disappointed… yet. the cloud shadows speckle the plains and a dust devil spins angrily not far from the road. I’ve got the obs/gyn book I brought open on my lap. I read it for the first ten or fifteen minutes of the trip, trying to review, but then we left our familiar town and I got distracted with the new countryside. the rhythmic bouncing of the bus has put thu to sleep. half finished houses whiz by, made of brick with no windows or roof. the cell phone company logos are everywhere, and any sign for a business or restaurant has the same girl drinking coco cola on it. car accident. It temporarily slows traffic, just as in the US, only there is no fire truck, no ambulance, only a tow truck loading the mutilated frame of the tiny car. I remember what thu said about this being a very dangerous road. I can see why. it is narrow and the cars go too fast. we pull off the road periodically to let a passenger or two go and pick up a handful more. cars honk as they pass. when the bus stops boys walk up to the windows trying to sell candy, cookies, or eggs.
“hapana asante, rafiki!” I have found this sentence to be the most useful way to get them to leave you alone. that, or to get asked on a date. we’ve been on the bus for almost an hour now. I can hear the radio of the bus over my music, ranting about something. a woman sits by the road sewing on an ancient machine. we pass a tree so large ten people couldn’t wrap their arms around the trunk. I can’t remember how long ago I saw the sign that said 52 km to moshi. my window is on the right side of the bus. when kilimanjaro appears, above the clouds and perfectly snow capped, it is to our left. I crane my neck to get a glimpse. anthony says he’s been here four months and it’s the first he’s seen the mountain. we were hoping for a better view, because when we left arusha there wasn’t a cloud in the sky. graziana has taken the bus to moshi already twice in hopes of seeing kili and has had no luck. today she is thrilled. and by the time we are busing back to arusha, as the sun is setting, the clouds are gone altogether and we get an incredible view of the tallest mountain on this continent. I want to climb it. another time, another trip. for now I’m going to focus on mt. meru. they say it’s harder to climb than kili but you can do it in fewer days. the sun was just dipping below the horizon as we drove past meru on our home. It was just as magnificent as kili in my opinion. crossing my fingers that climb works out.
we are an hour+ bus ride, then another hour+ dalla dalla ride from arusha to the jungle around kilimanjaro. we are hiking, our group of 12, led by a guide who stops periodically to rattle of trivial facts, some of which I’m quite certain he makes up. the kids come out from their huts and brick homes to follow us, beckoning our attention with little “jambo’s” and “mambo’s” and raised hands in hopes of reciprocated high fives. I high five every kid, don’t want anyone to feel left out. our guide picks up a chameleon with a stick. I’m very excited, never seen a chameleon in real life before! photos to come :)
the hike to the waterfall is a mini version of our first waterfall hike. lots of down. the thing about waterfalls is that they require large cliffs for the water to fall over, and deep valleys for it to fall into. to see waterfalls from below, you must hike into those deep valleys. rocket science, I know. they provided us with walking sticks. what a relief! the neatly carved stairs and sturdy railing were obviously not enough… catching the sarcasm yet? this is a tourist trap! carved walking sticks for each person in the group, really?! good thing we had connections and the whole thing ended up costing us about $6 each for all of the transportation, the guide, the rented walking sticks (?), everything. awesome. the waterfall was well worth tolerating gerber feeding during the hike. though not as tall as our first waterfall, it was still enormous and much wider. with the sun out, the beams were shimmering in the mist. shimmering is a cool word. shoes were off and everyone was wading around, climbing rocks, taking pictures, enjoying the refreshing mist. our guide would literally toss you over his shoulder and carry you from rock to rock if you didn’t want to get wet. again, we find ourselves in the middle of a jungle, in the middle of nowhere tanzania, (somewhere near kili, I know that much), and this time on the fourth of july. put a sparkler in my hand at that moment and I couldn’t have asked for anything more.
on the way back, and I don’t know how this happened in the half an hour or so we spent at the waterfall, a nest of fire ants was disturbed and the little guys were having a frenzy on the trail. the creepy thing about them is that you can hear them before you see them. creepy, or maybe fortunate, it serves as a good warning. just thinking about them makes me shiver. they are large and black and fast and hissing and have a bite to match how menacing they look. I contemplated staying down there at the waterfall until the trail cleared up because the only way to get past them, all running frantically in different directions, was basically to step right in the center of the swarm real fast then once you’re past, stomp a lot and hope they come off before biting. no thank you. Ill just hang out here until they leave. africa is not a place to hate bugs, if I could help it I would. I got past but don’t doubt there was some squealing involved.
all in all a great adventure – seems to be the theme of arusha. work week starts tomo and my friend andrew will be on a bus here by midweek to visit for a few days. he is a peace corps volunteer in southern tanzania. should be fun to have a semi-local around. happy fourth everyone!!
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