Saying Goodbye to Tanzania

Agnes, Jen, Pavan, and I have arrived in the Dar airport so early that they won’t let us in. This is a new predicament for me, kinda funny. I woke up at 5:30 to get ready and checked out of the hotel in Zanzibar, then we took the ferry back to Dar. I am so glad the my friends talked me into going to Zbar, it is such a calm and beautiful place. The sand felt like tons of flour had been dumped out on the ground. The water was turquoise. The people were more reserved, but also much more enthralled with our minimal ability to converse in Kiswahili.

I am quite sad to leave. I can’t believe how much I feel a part of this culture, these people, this land.

We are all planning ways to keep up our momentum when we return. The coming year will be intense academically, studying for board exams all year. So we will need all the energy and effort our friends can offer, to make these opportunities become reality.

One last note: Why Tanzania?
Because the doctor to patient ratio is 1:25,000
Because we have had our hearts softened to the condition of our most poor patients as we have lived some aspects of their lives along with them (sitting on top of laps and crammed into small spaces to fit on public transport, going without water, bartering for food, etc.). We were honored by them as they gave us their support when we were unable to maneuver through this new place on our own. We are a part of Tanzania and as a result, it will make us better physicians to our patients in Philadelphia.

Thank you for being a part of this with us!

-rachel, for the group

in Dar

Jen, Agnes, Pavan and I are now back in Dar. We rode the bus all day yesterday and arrived last night. It was really sad leaving Karatu. Everytime i heard bongo flavor music, i missed Mercy and the closer we got to the city, the more i missed everything we have grown to know and love.

we meet with the dean of Univ of Dar tommorrow

see you soon
rach

Joining Forces-Building Bridges

Today we went to Arusha to see Roopa off. Arusha is about 2.5 hours from Karatu. It has things like ice cream, cheese, and Chinese food: it is the virtual paradise of Northern Tanzania…but after a few hours, I was ready to come home – back to Karatu. Amazing how Karatu feels like home now.

So we are winding down now, heading back to Dar on Wednesday. But we are also gearing up, making plans for the coming year. There have been many exciting things happening in the past week. We have joined forces with an NGO here and are beginning to pursue a collaboration with them for first year students next summer. This NGO has been absolutely amazing to us, taking us in and introducing us to the medical system in Karatu. They have helped us get on good footing with the appropriate government offices here and we have an official invitation to come back and develop a long-standing collaboration with the hospitals in the Karatu region. He is excited with us, which is a welcomed gift, and is thinking big, daring to dream with us…that someday Karatu and Philly will be sisters. I like this very much!

So, to all our classmates who helped us get here in all your various ways of support, thank you so much for your work: making posters, storing supplies, organizing fundraisers, giving us contacts in Tanzania, helping us edit our proposals, etc. I hope you will all join us in the fall and make this program a lasting one. Start making plans for fourth year, we’re going back to Tanzania guys! – (yes, you too Timothy)

rach

19 Earthquakes

We have survived 19 earthquakes without a scratch. I just wanted to share that fact. As for our trip, we have made significant progress in building relationships here in Karatu. -Roopa

Puppy Poop

I finally had my chance to be in the or last week after everyone else in the group had been in to view the numerous c-sections that are done on a daily basis. Knowing that there was a woman in labor with twins that was going to need a c-section as well, I felt extra special to be able to be a part of it. Low and behold, as I get ready to head to the theater I'm told that another procedure will take place first before the c-section. Turns out my first operation in Tanzania was a hemorrhoidectomy. Yeah, I tried to be excited, BUTT (yes, BUTT), hemmorhoids are hemmorhoids. Don't think I've ever stared so long at someone's backside and don't think I ever will again. The whole thing lasted about an hour. I'm told that in more developed countries the procedure is shorter since certain tools allow for shortcuts in the or. The tanzanian doctors did everything "old school" and in the end I did learn a lot. You definitely need some skills to navigate around those things. It honestly all just looked like a big mess to me. I at least came out with a new found respect for proctology.

So far my favorite ward in the hospital is the pediatric ward. The really small kids are adorable and the older ones, 5-10 years old, are all really brave. They never seem to complain and only ever let on that there in pain when the pain is extremely severe. The most memorable patient thus far has been an 8 year old maasai boy who came in with what was initially thought to be a liver abscess. Once that was ruled out by ultrasound, meningitis was suspected and multiple attempts for a successful lumbar puncture were performed. This wasn't easy, seeing as the boy's body was extremely rigid. He was unable to bend his back at all, making the procedure extremely painful. The first few attempts were even done without any sort of local anesthetic. In the end, the boy was treated for tetanus. I've been out of the hospital because of illness and haven't seen him for the past two days so hopefully he'll be better when I see him tomorrow.

On the upside from the lack of electricity and cold weather here in Karatu, our hosts, MIHV, have a new puppy! It's name is Mtope, which means mud. She's already gone missing once, cried and yelped for the past two nights, and pooped twice in my room... but man the thing is so cute! It's a little bow-legged, smells, and isn't too bright, but it's hard to not like a puppy.

-Jen Jou

Flies, earthquakes, no power

This week has been a fun one – we have been without power since Monday. This means we have been wearing headlamps while we cook over the propane stove, kerosene lanterns while we eat, and flashlights while we brush our teeth – the stuff that bonds people... I love it! The least fun aspect of this week has been the flu that half of us came down with. We have had a sparse representation at the hospital as a result, but have been able to have several planning conversations which has helped us re-group for our final days here.

The earthquakes? Well I have counted 9 of them, one of them registering at a 6.0, but no structural damage.
The flies? A huge swarm came by the window one day, thousands of them, they waved hello and moved on and we still don’t know what it was all about.

We have all been shadowing the physicians at the hospital alongside an American physician who has been here volunteering as well. We are learning about the importance of seeing the same disease over and over again – the Tanzanian Doctors are pretty good at diagnosing malaria and TB even without the diagnostic technology we rely on back home. They are also under a tremendous patient load that prevents them from performing surgeries as quickly as they would like. There is a huge potential for collaboration in the near future which we hope to detail before we leave next week.

I had the pleasure of sitting with a 16 year old girl, pregnant, in labor, unable to deliver, and a baby that was in distress. I only knew a few appropriate Swahili words but sometimes words just aren’t necessary and I felt honored to be with her in that moment. She ended up having a c-section and a healthy baby, so that was very cool.

Well, my internet time is winding down.
We are all well and gathering many stories to tell.
Be prepared :)

rach

FINALLY in the hospitali!

Jen, Pavan, and I just walked back to town from the hospital, it took us an hour, but it is a sunny day and we had beautiful trees, sunflowers, and corn crops all around us. We have been working in the hospital since Wednesday and each day has opened our eyes to new things. I think today I really started feeling comfortable at the hospital. After going on rounds with the Doctors, I asked the nurse if I could help with anything and she let me help!!! So I was a courier taking charts to the pharmacy, bringing doctors orders to the Xray/EKG/ultrasound tech, finding the Dr. to get an explanation for one of his orders…I am learning a ton but it is a challenge to find ways to be helpful. Most of our influence is in greeting patients, smiling at them, holding their hands through difficult procedures. I guess it sounds simplistic, but the impact is huge. There is so much sickness here and so little hope to offer. I think the staff are burned out and desensitized, so our distance from this discouragement allows us to offer kindness to the patients that the staff are probably to tired to offer.

Yesterday was strange because someone we knew was admitted into the hospital – the lady who washes and cleans at the house where we stay. She fell and appeared to have a serious head/neck injury. It was frightening to realize that we NEEDED the health care to work, and that might possibly not be an option. The cool thing is that there are other volunteers here with us. We are learning the ropes alongside an American nurse and Doctor, and two German medical students. So we all joined forces and forged some new paths at the hospital. We got her 4 x-rays (a luxury) and had her on meds and diagnosed within an hour (a miracle).

I am loving being here. I have no doubt we are making a difference, and am even more certain that all of us are already permanently changed from what we have experienced.

I have 3 minutes of internet time, so I can’t write more now.

By the way, it is really nice to be distant from the distractions of internet, tv, phones, etc. I feel so much more alive. Wish there would be some way to keep that up when I return. Someone let me know if they have any ideas.

-rach

This is Africa

How do you tell a taxi where to pick you up when you don’t understand Swahili? Recruit Jen and Agnes to teach you a quick lesson that you will surely forget as soon as the conversation is over. :)

We have moved into new housing with some American volunteers here. They have graciously (that word is not strong enough) taken us in and now the four women will be staying in their house with them. We have shifted many times now and it feels good to know the bags can finally rest.

We are still working on getting into the hospital, getting ourselves into some sort of productive activity. In the meantime, we are getting to know many people and learning a ton about the region. We are also learning how to be flexible, patient, let our plans have time to work themselves out without our constant input…we are becoming a great team as well. I am glad we are here together.

We didn’t know we were going to get a lesson in local politics, but indeed this is exactly what we are learning. I am certain these lessons will play an important role in our future pursuits. But as we talked about this over dinner the other night, I was reminded by everyone in the group that we are here for the patients, we are here to help and we can’t loose sight of that. Whatever bullshit we have to dig through, it is worth it to be able to help those who are on the other side.

Some highly repeated phrases that have punctuated all our conversations so far:
“You are most welcome””Be free”
“There is somehow a problem””There is no problem”

From a desk at the ngo office, listening to beatles, wearing an African shirt, and sporting clean hair,

rachel

catching grasshoppers is fun!

don't have much time to write. 5 minutes left here at the internet cafe.
we moved into our new "temporary" home for the next few days, which is crawling or "hopping" with grasshoppers. don't you just love puns? we have running water and a toilet that flushes. although it takes 3 flushes to get a clean bowl. today is sunday, so there aren't any major plans. looking forward to being lazy and enjoying the weather. we'll be playing some frisbee later though. thanks to jen chou for all the donated frisbees!

-jenjou

Alexis's thoughts

Seeing as Rachel has commented on the logistics of the trip, I will talk about some of the things we have encountered in the hospital. Rachel and I arrived early in the morning and attended the daily religious service that they have. It was a very nice service because the Tanzanians really seem to enjoy the singing and praises that they give to God. It was a very joyful hymns that they sang and it was quite settling to the soul. After this, we entered the hospital with Dr. Mziray. It was a situation that is perhaps unimaginable in our minds. We first entered the Male Ward. Upon our first glance, we saw a patient who had rheumatic disease, congestive heart failure, and parasites in his stomach. His belly was inflated like a balloon, looking like it was about to pop. There was an immense amount of fluid in his peritoneum and the doctor had to drain it in order to relieve the pressure so that the patient could breathe. After waiting some time for the staff to bring the instruments, they brought a small bucket, a lancet, and a tube. They put it into the patient, and as he was wincing in pain, the fluid began to drain into this plastic bag in a bucket. The amazing part is that this is in a room filled with about 10-12 patients and this fluid had the possibility of spilling on the floor which was in the vicinity of 3 or 4 other patients. Continuing on to the next room, we came upon a patient who had a severe knife wound. It had penetrated his intestines and stomach, and they had performed an emergency surgery on him. When the doctor removed his clothing, the dressing was full of blood and did not seem like it was protecting much of the wound anymore. Moving forward we came across a patient that had TB and was on a feeding tube (a syringe filled with milk, connected to a tube going into the patients nose, being held by a piece of surgical tape). We then proceeded to the Pediatric ward. The most disheartening sight that I saw was a small baby that had meningitis. He had a tube in his nose and was very skinny and nonresponsive. His mother was waiting patiently by his side to see if he could improve. The overall demeanor of the doctors was interesting to me. It seems that they were a bit cold, and it was just not what we are used to being taught. I will have more to come in the future. For now thanks for reading.

Giraffes have long necks

So, its been a week. A crucial question has been answered that has plagued some of us in the group since march. Do chicken's lay fertilized or unfertilized eggs? The answer with 100% confidence from our Tanzanian friend Octavian is that chicken's lay both fertilized and unfertilized eggs.
Agnes referred to africa as a country. I rudely asked for a bill (didn't know the polite way at the time) in a restaurant full of people. The waitress laughed at me and instructed me in the right way. And I saw a giraffe on the roadside. Apparently, they aren't a big deal here.

After waiting in Dar for everyone to arrive and attempting to work with the ministry of health and immigration in Dar, Jenn, Agnes, Roopa, and I left for Karatu meet up with Alexis and Rachel. After meeting them we ate with an american family who visits karatu annualy. They cooked us dinner and gave us loads and loads of advice. Much to my dismay - their primary piece of advice is to go slowly. For those of you who know me, I only have one speed and thats fast. So Im learning how to use the breaks out here and take things slowly and to be very very very very flexible.

Luckily, we have met a few people from a minnesota NGO who have helped us navigate the political structure to solve our problems with immigration and allow us to volunteer at the hospital.

The most interesting thing so far however, was our group meeting with the student health club. These students are in secondary school ( a mix between High school and college). There were about 15 of them and their mission is to Promote awareness and prevention of HIV/AIDS and malaria. They are very well educated and have a very good understanding of HIV, its modes of transmission and types of treatments available.

I would like to ask you all a few of the questions that were asked of us - (We will share the answers that were discussed with you all when we return).
1) Why is HIV/AIDS so much more prevalent in Africa than America?
2) If you have a sick patient on a bed with who is very low on blood, and the hopsital has no blood bank and the only patient capable of donating blood has HIV. As a doctor, what would you do?
3) How should people in Africa go about making connections and spreading the word to little villages effectively? (Many of the villages speak very different languages and the literacy rate is low.)

Okay, we also met a couple of Sara Schuster's friends in DAR who are medical students at the University of Dar Es Salaam. They are very interested in collaborating with Temple in terms of research and they are also willing to help us coordinate our projects in Tanzania. They also said that the most efficient way to get invovled in Tanzania Healthcare is to be affiliated with a Tanzanian medical school. Something to seriously consider.

Dr. Harbison, if you read this - we are securing all the paperwork and contacts for you to come with no hassles and questions asked at any time of the year that is convenient to you. I hope that this is acceptable. I was also wondering if you could see if any of your colleagues, residents, staff or students would be interested in coming?

I wish you all the best and will do my best to stay connected digitally. Have a great summer. We're having a great winter over here.

Sincerely,
Pavan K. Thangudu

Today is saba saba day in Tanzania, so there is a huge market set up a mile down the road in the middle of a big field. EVERYONE is gonna be there sellng goats and handcrafts and whatever they have been waiting to sell. This year it is special because it is saba saba saba (7-7-07).

I am at an internet café waiting for the connection to free up so I won’t be able to write much. It has been a difficult and rewarding past few days. We have met a lot of wonderful people, both Tanzanian and American, though there is some red tape hassles that are taking awhile to clear up. We were without water for 3 days and that was perhaps the hardest thing yet. We also ran out of propane and haven’t quite figured out how to get it refilled, so eating cooked meals is a rarity and very much enjoyed. But we’ve already developed a lot of good friendships among the high school students and one of the ngo’s here. In fact, the ngo has taken us under wing and even offered free housing to us, giving us rides, introducing us to gov’t officials, and giving invaluable advice.

Yesterday we walked into town (hour walk) and kept waving for a ride/taxi/dalala. Finally we were picked up by a safari jeep who drove us in free of charge. The day before we hitched a ride from a jeep from the Lutheran Church. People here are amazing, so helpful and giving, going out of their way to help us. We have already made many good friendships and are slowly making our way through the red tape and learning about the politics of the region as well. It is much more complex than I had anticipated.

That is all for now. We are off to explore the market and celebrate with everyone from the town.

enjoy your water for us :)

rach

government holdups and lots of good friends

July 2, 2007

Alexis and I are finding our way around Karatu, led by our Peace Corps volunteer friends and some of the high school students nearby. Today we are officially on our own, except we are being guided by Octavian who is the student who leads the high school health club. He is an excellent guide in understanding and maneuvering through the town. We have had many conversations about health care in Karatu and also about his own career path that started in a remote village and hopefully will culminate in him becoming a physician.

We have run into problems with government officials. Apparently immigration is cracking down in Tanzania much like it is in the U.S. So our first meeting with the head physician of the hospital was very discouraging. We were not sure if we were going to be able to work in the hospital at all, as the officials were being harsh and holding up volunteers. The good thing is that as long as we didn’t give up, neither did our Tanzanian (and Peace Corps) hosts. So after many events and conversations, we are now set up to start in the hospital beginning tommorrow.

It is a very good thing that Alexis and I came ahead of everyone because we also have had to look for extra housing last minute. The cool thing is that our Peace Corps friend has graciously offered his home to all of us for this week and the hospital introduced us to a wonderful woman who will be able to provide affordable housing and meals.

I am excited to begin at the hospital. There is an American nurse visiting as well as an American engineer, an Austrian medical student, a German medical student, and an American Doctor will come next week. So we will all be working alongside each other at this 100 bed hospital. Our patients look to be a large number of maternity (a cesarian section every day, we hear) and a large number from the Masai villages. We hear that malaria is the number one illness and HIV/TB are also problems.

Thanks to our Peace Corps friend we are also going to be able to visit local health offices with some of the students from the health club at the local high school.

Alexis is taking lots of great pics and videos, so we will have lots more to show you when we return.

Salama

rach

Business in Dar es Salaam

My stress is slowly melting away as we find our way through this new environment and slowly get closer to our destination with our enormous amount of luggage in tow.

It's strange, I think it is hard to really conceptualize that we are in Africa. In some ways, it feels like Philly...like North Philly got magnified, had less resources, and became its own city. So far, the closest we have come to witnessing any extravagance is at the U.S. Embassy and at the Holiday Inn where we are staying (I actually feel ashamed to say I'm staying here, that is how nice it is in comparison to everything surrounding.) But the city itself is calm, very very chill. In fact, we haven't even gotten hassled other than at the airport when we arrived).

Oh, and we went to the Ministry of Health today...it was a mini-adventure. We had no address (other than a P.O. Box) and no name for a point of contact (other than "the registrar") but we knew this was the department that handled the official aspects of our interactions in the hospital in Tanzania. So we just walked around until we saw a door with a name that looked important, walked inside and talked to the person behind the desk. We then were led all around the building to about 6 different people. In the end, we made an appointment for the second group of med students to follow up on and then we headed out to buy our bus tickets for Karatu...and then off to the U.S. embassy to register our visit to Tanzania. The embassy was the most helpful part of the day, gave us a little background on some of the difficulties that medical volunteers run into when trying to start something new in Tanzania, and then put us in contact with someone at the Ministry of Health. So, off we went back to the MOH to put in one last plea. We finally made some headway with the main office there and even teased some smiles out of the staff there. So, we will pass on the baton to Group 2 and then we will see what happens from there.

I am looking forward to getting to Karatu. Nothing against Dar, but it is a lot of congestion without much benefit, and I'm itching to see the countryside. Our friend in Karatu already has some things lined up for us. We will be working with his high school students and following them as they gather information from local health care offices in regards to HIV treatment in the region. Once we get to Karatu, we won't have email access as readily so this may be the last lengthy post from me for awhile.

Today, we walked by the National museum and House of Culture, so we stopped in. I was surprised by the layout, it was very simple, but very good. The only bad part was when my jet lag slammed me. I was standing there reading about one of the exhibits when my eyes closed and I nearly fell over. I would have laughed at myself if I had had the energy. I did enjoy the museum, though. Colonial rule of Africa is nauseating but the whole thing was presented without commentary, allowing you to make your own conclusions (or not, if you so chose).

The straightforwardness and simplicity of the museum seemed important, like it was trying to say something about the mindset of the country. I sense there is something about Tanzania that is quite unique from any of the places I've traveled, but I haven't yet figured out what it is. Their exhibits were on either science and evolution, or the history/culture of Tanzania. I wondered why these things were put together...it seemed as if the museum saw them as connected topics essential to explaining Tanzania. I liked it. It showed the people of Tanzania as a unique but connected part of the whole of human history. It was as if someone said "Build a museum that explains what has made Tanzania the unique people/place it is today" and they answered by starting at the very beginning.

I miss my friends and family, by the way...in case you think the distance makes people forget their home...it doesn't. We are storing up stories/pictures/videos and you all will get to share some part so that we don't feel we've left our home behind. :)
rachel

Arrival in Dar

Alexis and Rachel are in our hotel in Dar. This is a calm city so far, and we are going to try and get our bearings soon.

Peace
rach

pictures and facts about the hospital

These pictures of Karatu Lutheran Hospital speak volumes:
http://health.elct.or.tz/karatu/picture%20gallery.htm

The following are articles written in German. So paste the link into google and do a search. In the search results, rather than clicking on the link, click to the right of it on “translate this page”. These are excellent first-hand accounts of the hospital, its resources and needs, and the patients:

http://www.stethosglobe.de/ausland/fam/gyn_eat_04-2005_rc.php

http://www.samariterbund.net/noe/aktuelles/941?PHPSESSID=55e9aad4f636be762716d926bd96bb8a

These files are in English, they are first-hand accounts from missionaries to the region (there is a lot of useful info in theses:

http://www.interchurch.org/resources/uploads/files/237HRM_Cost_Recovery_Assessment--Tanzania_CSSC_Hospital.doc

http://mysite.verizon.net/vzerxijl/id15.html

Welcome

Welcome to the blogspot for Temple University International Health Organization. This is intended to allow members of TUIHO to communicate and organize for upcoming trips and to remain in close contact.

For any problems, please email jcchou@temple.edu