Tales from Tanzania

Farewell Lindi, TZ and final blog:(

2009-06-17T06:40:00.000-07:00

I said goodbye to my colleagues and friends of the hospital last night at my 'farewell party'. Hosted by the Doctor-in-charge and coordinated by one of the head Maternity nurses and medical staff, the party was held at one of the hotels on the beach. About forty people turned out to help me say goodbye.
Speeches were made, followed by drinks and food, and then a little bit of dancing to end the night.
Up on stage with the Doctor-in-charge and Regional Administrative Secretary.

Our local DJ on the job.

Cheers to everyone

Dancing at the end of the night!
Tomorrow I'm flying north to Kilimanjaro for the start of my safari in the Serengetti!

Hospital Pictures

2009-06-10T09:29:00.001-07:00

This is our Maternity Ward. There are about 14 beds and usually about 20-30 patients in the ward! Maybe you can see in the back of the ward, most of the beds are shared by two, sometimes three patients! We are lucky to have received brand new beds with mosquito nets from Mama Salma Kikwete, the first Lady of Tanzania, who recently came to Lindi to donate beds and equipment. Its a full ward round day, meaning we see and examine all of the patients in Maternity Department. Farther back in the ward, through the double doors is "Labor and Delivery" where patients are brought for triage and for delivery. There are 3 delivery "beds". In our hospital we are doing on average about 140 deliveries per month so those 3 delivery beds are usually always full!

This young girl is 16. She just delivered twins by cesarian section. I think she is actually lucky. There are so many teenage girls who come very late to the hospital or get referred from a dispensary after having been in labor for 2 to 3 days. They often end up with an IUFD (Intrauterine Fetal Demise) and unfortunately a VVF (Vesicovaginal fistula). While this girl managed to deliver healthy twins, she will need alot of social support being only 16 and a new mother!

Here you see our "sterile speculums" and other "sterile equipment". The equipment has in fact been "sterilized" in an autoclave but certainly you would not be able to guess by the look of these! Our patients don't complain nor do they even seem to notice!

I only have 7 days left in Lindi. A lot of mixed emotions! There are many things I'll miss and many I will be happy to leave behind. In fact I only have 5 working days left, but who is counting!

What I'm really going to miss most is the people I've met here in Africa - some very extraordinarily genuine people. There is one particular author, Kuki Gallmann, who describes Africans as "People for whom tradition is important and to whom family values still matter; people who protect the young and respect the old, care for the sick and feed the hungry, even if it means sharing the little that they have; generous people, ready to smile and to forgive; people with a song in their heart and a dance in their step; enduring, compassionate and infintely patient." (From the novel 'African Nights'). I think this is a very accurate description.

Remembering Chitanda

2009-06-08T08:19:00.001-07:00

Chitanda was one of the two x-ray technicians working in the hospital. He died early this morning in the hospital due to severe Malaria and pneumonia.

Chitanda was probably in his mid fifties and had worked at the hospital for over twenty years! Since I started work in September I saw him every day working as usual. He was an integral part of the x-ray department! I come to x-ray to scan patients for ultrasound and perform HSG's (Hysterosalpingograms) - a study used to evaluate patients with infertility and other gynecologic disorders. I could always tell if the HSG showed some significant finding by the look on Chitanda's face when he came out of the developing room with the film. If there was a smile on his face, the patient either had some evidence of tubal disease or a uterine filling defect. If his face was expressionless, the study was probably normal:)

I spent much of the day today in the x-ray department and I couldn't help but spend most my time feeling sorry for Chitanda's family and for his long time friend and co-worker, Juma, who like Chitanda has worked in the x-ray department for over twenty years, and spent almost everyday working together with his friend and co-worker.

Chitanda was admitted to the hospital with Malaria last week, then discharged home after about five to seven days of treatment; then he was re-admitted a few days ago. His condition deteriorated and he passed away this morning. I stopped by his room in the hospital to check on him and give him my condolensces last week, and was expecting he would bounce back in no time! But unfortunately he did not make it.

Chitanda's funeral service will be tomorrow morning. I am really hoping to attend, but these days a number of the clinical officers are away from the hospital and as we're short staffed already, I'm afraid I'm probably going to be spending the day in the hospital and clinic.

My condolensces to all of Chitanda's family and friends who will be at the funeral tomorrow!

The patients

2009-06-03T05:54:00.001-07:00

There are some patients I meet that I will remember for a long time. Their names will escape me but their stories I'll remember. Sometimes the patients who make lasting impressions on me have good outcomes with happy endings but more often than not the patients who I remember are the sad cases with very unfortunate outcomes.
I met the patient above in the ultrasound room today. She is a 60 year old woman who came with increasing abdominal pain and early satiety. By the looks of her abdomen you would think she's about to deliver! But unfortunately this patient has an advanced stage cancer probably of ovarian origin. The ultrasound showed a ton of ascites and a large pelvic mass. I wanted to admit this patient to the gyn ward for exploratory laparotomy for diagnostic/therapeutic purposes, but the patient declined. Her relative explained that her family has no money and can't afford an operation. I told her that she would have to pay Tsh 6,000 (about $6 US dollars). She said she has to go home first to collect her belongings and discuss with her other relatives. I had to agree with her plan and I let her go home. (Unfortunately) I am not allowed to waive the fee for surgery or personally help patients pay for surgery. I'm sure the financial issue was one of the reasons for presenting to the hospital at such a late stage!!

Here we are preparing a patient for a cesarian section.

This young girl is only 22. She has a full term pregnancy, one previous cesarian section (when she was 16 years old) and she is HIV +. She came to the hospital alone, without any relatives! Although she does say that she has a husband, he wasn't around. The cesarian section went well but she had a ton of adhesions in the abdomen/pelvis. The baby had good apgars but we won't know if the baby is HIV+ for another couple of weeks.

I took this picture in the operating "theatre" just before the cesarian section. I'm lucky to use this operating theatre which was just constructed last year and opened about a couple of months ago. There is plenty of space and much better light source compared to the small, dark, operating theatre we had been temporarily using when I arrived in September!!

Miss Lindi 2009

2009-05-31T04:05:00.001-07:00

The Miss Lindi 2009 Beauty Pageant was held last night at the Oceanic Hotel. Hundreds of people turned out to see 10 girls compete for the right to become 'Miss Lindi 2009'. The pageant consisted of a short dance intro by all of the girls, followed by rounds of swim wear, an evening gown display, talent show, and final round question to be answered by the finalists. After all of the rounds were finished contestant number 4 (above) won. She seemed to be the favorite from the start and had the most number of fans cheering for her in the crowd.

The event was surprisingly well organized and was held at the nicest venue in Lindi, The Hotel Oceanic. Sponsored by Vodacom, one of the largest telecom companies in Tanzania, there were a few short speaches made by managers of the company as well as members of Lindi District preceding the comencement of the event.

Once the opening speaches and introductions were over, the 10 girls came out and danced for a little while and then went back stage to prepare for round number 1 - swimwear (my personal favorite:).

The next round, evening wear was also enjoyable. The third round, talent, was a much shorter round than the rest because only four or five girls decided to put on a show of talent which consisted of either singing or dancing.

The contestants were narrowed down to the top five and each of the finalists was asked the same question by the judges, "What would you do to help development in the district of Lindi if you are selected to become Miss Lindi 2009?" The winner had a well organized answer consisting of addressing different sectors - education, health and as well, hoping for support from the Tanzanian government. Her answer was given in Kiswahili so my translation may be slightly off!

It was a good night. I sat in the front row of the "will call" general seating directly behind the VIP area so I had a clear shot at the stage. Entrance fee was $5 for general admission, $20 for VIP, which included a dinner buffet. On my salary here, $5 is alot! So I opted for general seating!

That's all I have for you for now. Until next time......

Mama Kikwete

2009-05-26T11:02:00.000-07:00

The First Lady of Tanzania, Mama Salma Kikwete, wife of President Kikwete, came to Lindi Sokoine Hospital today to visit the new Maternity Ward and to donate new beds and new equipment to be used in the Maternity Ward.
When Mama Kikwete arrived, she headed straight to the maternity ward to see the new equipment and beds which had already arrived a few days prior. Before entering the ward, she passed by all of the doctors working in Maternity, including myself. She offered a greeting to each of the doctors in Kiswahili, however, to me, she said "how are you?". I said "safi" or great! It was the only exchange I had with Mama Kikwete.

After she passed through the ward, she returned to the podium where a few brief speaches were made by the Doctor In Charge and Regional Medical Officer, followed by a speach by Mama Kikwete. After her speach, she left the podium to cut a ribbon around two of the new beds donated to the hospital.

There really was alot of local support, as Mama Kikwete is from Lindi and I'm told she was actually born in Sokoine Hospital!

Fishing

2009-05-26T10:53:00.001-07:00

I went fishing on Sunday. Here I am with two local fisherman aboard their handmade wooden boat. We set out about 8 in the morning into Lindi Bay heading due east toward the Indian Ocean. We first headed out a bit north to pick up our bait which consisted of "daga" or little fish. We set out further into the bay, made one stop along a remote beach to pick up some logs in order to build a small roof for the boat to protect us from the blazing heat of the sun. We set out further into the bay and started fishing.

We caught six or seven small fish - bluefish, redsnapper, "changu", two fish called the "double beard" fish or in Kiswahili is called Mchuichui, or something like that. There were 3 local fisherman, myself and one German development worker whom I recently met in the town.

It was just a nice day to be out in the bay! I personally didn't catch any fish but I was there to take pictures and offer my encouragement and moral support. Go to my facebook page to see the rest of the pictures from my fishing excursion.

Swine Flu and other hogwash

2009-05-02T07:54:00.000-07:00

Swine Flu is spreading like pork buns in a dim sum restaurant!
As far as I know there have not been any reported cases in Tanzania (yet?). People ARE worried about a possible pandemic. The CEO of VSO sent out a mass email the other day warning people about this possible pandemic. And doctors in the hospital here in Lindi are talking about swine. We are scheduled to listen to a presentation on Swine Flu on Wednesday.

Other hogwash worth mentioning - a bunch of bombs went off in Dar Es Salaam last week, killing about sixty people (I believe that is the number quoted). I don't know how or why the bombs went off but it caused alot of panic among people living in Dar. As far as I know there are no bombs here in Lindi, or so I'm told!

On a very sad note, on Thursday evening, as I was about to go to sleep, I received very disturbing news. One of the VSO volunteers had been involved in a traffic accident and died while riding her bike in Tanzania's capital city of Dodoma. I was shocked and very saddened by the news. I had spent alot of time with this person as we studied Intermediate Kiswahili together last year in Morogoro! Apparently I was told that the tire of a taxi blew out causing one of the buses in the street to swerve and knock her off her bike! I don't have all of the details about this case and I'm told that VSO is still collecting information.

Switching gears, I met my first 'Androgen Insensitivity Syndrome' patient on Thursday. AIS is basically a rare condition affecting about 1/1200 women in which the uterus and cervix does not develop. These people are 'phenotypically' women but have 46 xy chromosomes (genotypically male). The diagnosis has to be confirmed by karyotyping but I'm fairly sure of the diagnosis based on her presentation. She came in complaining of primary amenorrhea (never having a period) at age 21. I had to ask one of the Tanzanian doctors to help me translate counseling this patient as it would be a very time consuming, delicate subject to discuss and necessitate answering many questions! We ended up referring the patient to Dar Es Salaam for karyotyping and genetic counseling. She may need orchiectomy if she is confirmed to have AIS.

Friday was a holiday here in Tanzania. I spent the morning doing a bit of reading on the beach. In the afternoon I went to the 'football' stadium to watch two of the local soccer teams play. It was a blow out, 3-0. The local team lost. There were a few visitors who received nasty looks when they cheared for goals by the visiting team. I captured most of the game on video.

That's all the news I have for you for now. Enjoy the weekend!

Case of the day

2009-04-27T09:13:00.000-07:00

This morning I examined a post op patient who had a c/section 2 days ago. She had difficulty breathing, was febrile with a distended abdomen and rebound tenderness on exam. I scanned the patient and found that she didn't have any significant amount of fluid in the abdomen or pelvis so we treated her as severe peritonitis with broad spectrum antibiotics.

A moment later, I was called to do an emergent ultrasound on a patient admitted in the female medical ward. She was admitted with severe constipation, nausea and vomiting and she too had a distended abdomen with rebound tenderness. Her scan revealed a normal size uterus with what appeared to be a small intrauterine gestational sac without a fetal pole or yolk sac. There was a small adnexal mass and significant amount of free fluid in the cul de sac. I took her to the OR for laparotomy expecting to find a ruptured ectopic or ruptured hemorrhagic ovarian cyst. However, on opening we found diffuse, grossly dilated loops of small bowel with diffuse adhesions throughout the abdomen and pelvis - an acute small bowel obstruction. We ran the bowel and found a small area of ischemia however, no gross devitalized or necrotic tissue, so we performed extensive lysis of adhesions and closed. She'll get a nasogastric tube for at least 48 hours and conservative therapy post op.

The maternity ward was busy. I performed a cesarian section this morning on a patient with cephalopelvic dispraportion (CPD). It was her first pregnancy and she was lucky to have come to the hospital in time to be evaluated before potentially ending her pregnancy with a bad outcome!

More to come...

April Showers

2009-04-25T06:02:00.000-07:00

We've had a few days of rain this month and just brief showers today. April is usually the last month of rains before the dry season from the beginning of May until around November.....

Practically this is not a good thing for me because I collect the rain water to use for bathing. Without rain I am buying water. Today I used up the last remaining drops of the water which I had collected from the rains. There was no more running water this morning so I went to my neighbor's house to buy about 20 liters of water (for almost $1).

At work its been busy as usual. There are always about 30-40 patients a day in the outpatient clinic. But towards the end of the week, the numbers usually decrease a bit. On Thursday I went on a "supervision of study", meaning that I travel to neighboring cities of Ndanda, Mtwara and Nyangao to visit the participating hospitals in this study. We are working on the "Misoprostol in Retained Placenta" Study. Patients with retained placentas are randomly given a placebo medication vs. misoprostol at the time of diagnosis of retained placenta. About once a month I travel to the three other participating hospitals along with one of the head Maternity nurses to follow up on the progress of the study. Its nice to get out of Lindi and to see the country and as well see people who I used to work with in Ndanda. But its a long day, we leave around 9 in the morning and get back by sunset.

My last day of work will be June 17th. I'm traveling up north to Arusha the following day and then going on a safari in Lake Manyara, Serengetti and Ngorongoro. June 23rd I'm flying back to the States. This means that I have only about 6 weeks left here in Tanzania! I'm sure the time is going to fly by. There are so many things I'm going to miss and a lot of things I'm looking forward to leaving behind here in Tanzania. I've started to compile this list and I'm going to publish in one of my upcoming blogs!

Duty Calls

2009-04-09T09:40:00.000-07:00

Its been so busy at the hospital this week. Maybe because Tuesday was a national holiday and as well tomorrow and Monday are holidays. Everyone who is sick or just passing by the hospital is coming in for a health check up. It looked like hundreds of people had gathered around the reception area this morning to get a chart in order to see a doctor. About forty or fifty patients were seen in the ob/gyn room. Patients had everything from normal pregnancies to various gyn cancers.

I started the day with one elective cesarian section for a woman in her third pregnancy at term who has a "bad obstetric history". She delivered a healthy male who came out screaming.

After the elective c-section, I went to the OPD to see patients and then finished the day at ultrasound scanning patients. I saw a few interesting cases - one patient was a consult - she came with acute appendicitis and one woman I scanned had a bladder cancer.

I was home by about 5 and ate one of my favorite dishes - baked chicken with rice and vegetables.

The sun sets around 6:30 these days and if I'm lucky to have electricity at night I've been spending my evenings relaxing watching the second season of "Dexter" on DVD or doing some light reading.

I've notified the hospital here in Lindi that I'll be returning home to the States early. June 23rd is my expected date of departure from Tanzania. I'm planning to spend the weekend of the 19th up north around Arusha and Serengeti National Park.

For those who don't know already, I signed a contract for work when I was back home in the US last month. I'm going to work for Carlisle Regional Medical Center in Carlisle, Pennsylvania. July 13th is my start date! Very excited! Carlisle is about two hours from DC/NY and Baltimore in Central/Southern, PA close to Hershey and Harrisburg. See the website www.carlislermc.com

April Fools

2009-04-01T07:23:00.000-07:00

Yesterday morning my 'program manager' in Dar Es Salaam called to tell me that the VSO office is conducting an Evacuation Test. If, for example, there was political unrest in the country and all volunteers were needed to evacuate, we would need you to follow the following instructions, he said. He told me that I must go to Mtwara right away. From there I would go straight to the airport, board a flight to Dar Es Salaam and get a connecting flight to the US. He asked me if I would be able to leave the hospital right away or if I would prefer he would call the Doctor in Charge of the hospital. I told him to call the Doctor in Charge. Two minutes later he called me and told me that a car would be available for me to leave the hospital. He told me that I should pay for the fuel to take me to Mtwara and then I would be reimbursed once I arrive in Dar. He said that the VSO office will be closed for four weeks during this evacuation, so I should plan to pack my bags to stay out of the country for the entire four weeks! I told him that I am really not ready to take a two hour drive to Mtwara, fly to Dar and then potentially fly back to the US, especially having just recently flown back here from the US. He told me I should go ahead and pack my bags and take the car to Mtwara. He said I should expect a call in two hours to get an update. I said to him, 'do you really want me to take a car to Mtwara even though this is a test?' and he said yes - I should go ahead and do it! I said 'But I don't have a ticket to fly to Dar!' He said yes, you do, an e-ticket has already been issued for you which you will receive at the airport. And once you get to Dar you will receive the e-ticket to return to the US'. He told me I would be flying Emirates and have a layover in Dubai. After more questions and more answers, he convinced me that I needed to get in the car and leave Lindi.

So I found the hospital driver, went to my house, packed a couple of suitcases and then began the drive to Mtwara. Two hours later my phone rings; my program manager tells me that I must return to Lindi right away; this was just a test. A test! What?? He said 'I thought I made myself clear on the phone', you were not supposed to leave Lindi!

I don't know if I was the victim of a bad April fools joke or if I just completey misunderstood my manager in Dar, but what a frustratingly painful thing that was to go through yesterday. I wasn't laughing when we had to stop the car and turn around an hour and a half away from Lindi!

Apparently the program manager's 'Evacuation Test' had the same effect on many of the other volunteers in the region who were also en route to Mtwara! There was an apologetic email sent out to all the volunteers who, like me, took the Evacuation Test seriously.

On a better note, today was a productive day. I had one operation scheduled this morning - an abdominal hysterectomy on a perimenopausal woman with a large fibroid uterus. The uterus was about three times the size of normal with large fibroids. The case went smoothly without any complications. I spent the afternoon in and out of the clinic as well as in ultrasound, scanning a few patients.

Happy April Fools Day!
More to come from the most gullible volunteer in Tanzania!

Bongo Flava

2009-03-28T05:39:00.000-07:00

I arrived safely back to Tanzania 8 days ago. Nice couple of flights on KLM, with a short layover in Amsterdam. I landed in Dar Friday night and took a cab to my favorite hotel, the Econo Lodge. I spent the weekend relaxing and trying to adjust as quickly as possible to the time difference (8 hours ahead) here in Tanzania. The weather has been just as I had left, hot and humid, day and night!

I spent Saturday at the beach relaxing with another volunteer based in Dar Es Salaam.
There are plenty of "resort" style beaches in Dar and if you go to one of the more popular beaches on a nice weekend you'll find a ton of "wazungus" (White European descent) lying out or walking around. Almost gives you a feeling like you are not in Tanzania but at a resort in the Caribbean!

On Monday I stopped by the VSO office to meet with my program manager to discuss how the job in Lindi is going and to discuss other issues coming up in the next couple of months.

I flew down to Mtwara (the largest city in Southeast Tanzania close to Mozambique) on Wednesday and from there I took a dala dala (overcrowded public transportation minibus) to Lindi (about two hours north).

In Lindi I took a cab back to my house in the town of Mtanda. There I met Hadija, my housekeeper who I was happy to see and to hear that everything had been well at my house, i.e, no robberies or attempts at break-in.

I found the house just as I had left it - without water and with very sporadic bouts of electricity that seem to come and go at completely random times. My first night back in the house I had no electricity for most of the night. I spent the evening with my security guard sitting around in the dark talking by candlelight. I was lucky to have about 25 liters of water which had been collected from a recent downpour but that water was soon consumed and I'm now left with buckets of water used very sparingly!

I went back to work at the hospital on Thursday. I spend most of the morning doing "ward rounds", meaning I see all the Maternity patients (antepartum, post partum and laboring patients) and Gyn patients who are admitted in the ward. Fortunately there were no very sick patients in-house. We had a few patients with prolonged hospital stays due to post op wound infections. There was one patient admitted to the gyn ward with a large adnexal mass awaiting surgery and another patient in preterm labor at 32 weeks of gestation. In the afternoon I went to clinic and saw about a dozen patients. The most interesting case of the day was a relatively young woman who was diagnosed with cervical cancer. She went to Dar Es Salaam last year to receive radiation therapy. She came for a follow up and seems to be doing well with normal blood counts, however on exam she still has evidence of a large residual tumor mass on the cervix. I told her that she should go back to Dar Es Salaam to potentially receive more radiation therapy. There were two or three patients with infertility who came and got a work up. I scanned about a dozen patients in ultrasound and then went home for the day.

Hadija had prepared fish (red snapper) with vegetables and rice. It was plenty of food for me with leftovers remaining for the next day.

On Friday I had two operations scheduled - an elective repeat cesarian section and tubal ligation for a woman who is HIV+ with a history of one prior cesarian section and undesired fertility. She had an uncomplicated repeat cesarian section and delivered a vigorous baby boy.

The second case of the day was also HIV+. She was a young woman with a large ovarian mass. We found about a 10cm hemorrhagic ovarian cyst at laparotomy and performed oophorectomy. She was recovering well when I checked on her at the end of the day.

I saw a few more patients in clinic yesterday afternoon. More infertility patients arrived and a few patients came for regular antenatal care.

Last night I went to the Santorini bar, a nice local hangout on the beach to relax and get a drink. The laid-back social scene here is something that I will miss. There are no "wazungus" which I socialize with outside of the hospital, but there are plenty of friendly Tanzanians who like to relax at the bar and go dancing until early hours in the morning.

I'm heading to the market now to stock up on some fish and meat, fruits and vegetables and then do a little bit of work at home. Badaaye! (See you later!)

A Taste of India

2009-03-16T17:13:00.000-07:00

Had dinner at Rasika (http://www.rasikarestaurant.com/) this evening. Excellent food! Their "flash fried" spinach appetizer was voted best appetizer in Washington DC! The cod, chicken and lamb were excellent. Service was good, but we waited an extra long time for the cod to come out.
I say "extra long time" with tongue in cheek because coming from Tanzania, one can expect to wait upwards to two hours for food to be served in a restaurant and then of course you can expect your food to be served cold. Many of the local Tanzanians will jokingly saying "TIT" meaning "This is Tanzania" when referencing the long wait for food at restaurants.

There's no "flash fried" spinach appetizers in Tanzania. Its even difficult to find a good chicken dish. There are a few good Indian restaurants in Dar Es Salaam, and the quality of food seems to be getting better, but the food in Tanzania doesn't compare to the food in the States, as you can imagine.

So, I'll be back in Tanzania in 3 days. Thursday evening I'm flying back. I've got a 10 hour flight to Amsterdam and then about 10 hours from Amsterdam to Dar Es Salaam. Once I'm in Dar, I have an option of taking the 10 hour bus ride from Dar Es Salaam to Lindi (2 hours of unpaved road) or taking a 2 hour flight. I think I'm going to opt for the 2 hour flight!

Besides adjusting to the 8 hour time difference, it will be interesting to see how quickly/how difficult it will be to communicate in Kiswahili again. When I left Tanzania last month I had been almost fluent in Kiswahili. Speaking and comprehending Kiswahili was easy. I was even thinking in Kiswahili! These days I find myself searching for words when I imagine speaking in Kiswahili again.

So, I only have two more dinners, and two more nights to spend with family and friends!!! I'm going to miss the food and the company of friends and family!! And of course the addicting evening TV series "The Apprentice - Celebrity Season". My question to you is, Why did Tom Green get "fired" last night?? He was a good manager, even though his team did loose to the girls by over $400.....

But getting back to Tanzania will be a nice feeling. I'll be happy to be back even if it is for a short period of time. I'm finding myself missing the hospital and being in the clinical setting. Despite the endless lines of patients, the never-ending ultrasound scans, the unpredictability of the electricity and the frustration with medical personnel, I am missing my work which I only remember with great satisfaction and personal fulfillment.

Cheers!

Red, White and Blue

2009-02-20T16:29:00.000-08:00

It feels great to be back in the US!

I arrived in DC last week (last Friday), after two days of flights and a 10 hour bus ride. I was exhausted from the jet lag but once I landed and got in the car at Dulles I went straight to a restaurant in Georgetown and ordered a nice big juicy burger! Forget about the fat or calories, the burger is something that I have been craving for about the last 6 months! It was excellent too, nice and juicy! I don't want to complain about the food in Tanzania because I have an excellent housekeeper who is a great cook, but there is nothing better than indulging in a great beef burger!

After I digested my food, I settled in for the night as it was about 4 in the morning to me. Fortunately I think I adjusted to the time difference pretty quickly but I was battling a little bit of a cold the first few days back! The weather is so colddd! But it actually feels great compared to the swelting heat blaze of Tanzania! I know most people are probably hating me for writing about nice cold weather about now!

Well I want to fast forward a bit. Its been a week since I've been back in the States and I'm very happy to say that I feel like I've brought myself up to speed on all of the latest news with the global economic crisis. I've been glued to the tube watching CNN and MSNBC!

There were a couple of great panel discussions broadcast on CSPAN today, the first panel was a group of UPenn business/economic/finance professors discussing the state of the economy. And in the the last hour there was broadcast of the 'World Economic Forum' from Switzerland.....very interesting to hear some of these politicians and businessmen speak about these issues. From my perspective it is great to get caught up on all of the latest news but I would imagine for most Americans, reading the daily headlines of housing foreclosures and people loosing jobs must get depressing!

Anyway, that is about it. I'm thinking if possible I want to make a mini trip to NY in the next couple of weeks to visit friends. We will see.....

Happy Belated Valentines Day. There is no romance in the air for me this year, hopefully next year:)
Bye Bye

What are you, chicken?

2009-01-27T08:28:00.000-08:00

Don't count your chickens before they hatch. Well I'm counting my chickens and as of today they are two! For about eleven dollars I bought two chickens in the market (live chickens, not the kind wrapped in saran wrap in the frozen section of the supermarket). The plan is to raise chicks for fresh eggs and after they "beef up" abit, I plan to enhance my diet with a variety of tasty white meats:) I took this picture because, for some reason I'm not ashamed or embarrased to prove to you that, I am now the (proud) owner of two chicks:)

As far as my dogs go, I'm sorry to say that my remaining dog, McCain passed away yesterday morning. She was so depressed, she wouldn't eat or drink. She died peacefully and for that reason I'm partly glad that she won't suffer from the loss of her brother and sister any longer.

At the hospital, work has been going well. Today I saw about twenty patients in the clinic, which has been about the average number of patients I see in clinic each day. In my down time I pass through the maternity ward or go to ultrasound to scan pregnant, and gyn patients.

There were a couple of interesting patients. One patient came to me telling me she had a 9 month pregnancy with symptoms consistent with an upper respiratory tract infection. She told me that she had been feeling fetal movement up until the last week. She showed me her antenatal clinic card which had documented her antenatal clinic appointments for the past few months. On exam she was obese and had a slightly distended abdomen, although I couldn't feel the fundus of the uterus. I scanned the patient and it looks like for the past nine months, her "pregnancy" was in fact an ovarian mass! The uterus was normal size and the cavity was empty. I informed the patient that unfortunately she won't be expecting to deliver a baby any time soon.

Yesterday I received a not-so pleasant surprise from Tanesco (Tanzania's Electrical Supply Company). One of the electricians came to my house and literally pulled the plug on my electricity. He told my housekeeper that he was cutting my electricity because I haven't paid any of my bills since I arrived in the house in September. (None of the bills had ever reached my house or the hospital btw). So today I went to Tanesco and received a bill for the months of October through December which totaled about twenty-six dollars. I also received my bill for the month of January which came to about one hundred dollars. I laughed when I saw the amount of the bill and argued with the manager, but he insisted that the amount is correct. To make a long story short, I now have electricity again and I am waiting to hear from the hospital as to whether or not they will reimburse me for the cost of electricity.

Tomorrow is an OP (operating day). It will be a light OR day as we are preparing to move into the newly constructed operating room. I have one case scheduled - a rescue cerclage for a woman with an "incompetant cervix". She has a pregnancy of twenty-two weeks with a cervix dilated 3 centimeters (and no preterm contractions).

Sorry for such a lengthy note today. I think I've cheered up a bit since the death of (all of) my dogs this week:( And in addition, I'd like to ask you the following question - What are you, Chicken? Bwak Bwak!:)

A Day of Mourning

2009-01-23T07:17:00.000-08:00

I am feeling so depressed! I woke up this morning, started getting ready for work, and just as I was finishing my breakfast, my guard informed me that one of my dogs, Bush died! I went outside and there she was lying dead next to the dog house:( I was literally dumbfounded and shocked to see her lying dead.

Last night Bush and Obama had snuck out beneath my fence and wandered around. Obama came back very late last night around 10pm looking ill. Bush didn't return until sometime during the middle of the night and then was found dead this morning!

Meanwhile I went to work and tried to be productive while feeling depressed and wondering how my dog could have died! A little later in the morning I got a phone call from my housekeeper that another one of my dogs, Obama, was looking very sick. I went to the market to buy some dog medicine and when I got back home, I found Obama dead! He was lying next to the dog house, dead!

My last dog, McCain was the only one who didn't sneak out last night and she is healthy as far as I can tell.

It sounds "cheezy" to say, but I am really choked up and feeling very sad about losing two of my dogs (on the same day!). I was really attached to them after only four months! And what really kills me is seeing McCain run around the property looking for her brother and sister!! I am embarrased to say that I was almost in tears this afternoon....

Who knows what happened when Bush and Obama snuck out last night but something terrible must have happened. Both dogs were doing fine just a couple of days ago! I was thinking that possibly they may have acquired a terrible stomach virus after eating part of a dead animal last week, but there is something to be said about both dogs dying one after another after being outside my property last night.

The last dog that I had, Lucy, passed away a number of years ago and I forgot how painful it is to loose a dog...... its like loosing a family member! And to loose two dogs on the same day is painful!

Who knows what a dog's memory is like but I think McCain must know that her brother and sister are dead because she saw my security guard carrying Bush's body outside the property this morning and she walked with me while I carried Obama outside later in the morning. I just hope she doesn't have such a good long term memory!

I'm trying to keep my mind off of the tragedy today. But its hard! One of my drivers asked if I will get new dogs....the thought of getting new dogs hadn't even crossed my mind. Its too painful to get attached to these dogs and then loose them!

I'm sorry to leave this blog on such a sad note, I'll try to cheer up and post something on a more positive note next time :)

Hope

2009-01-20T10:19:00.000-08:00

Inauguration day! What was it like in Lindi Tanzania?! Well fortunately CNN broadcasts live in southern Tanzania. Hours before the swearing in ceremony, I sat and watched, glued to the TV as I saw millions of Americans on the mall surrounding the capital. What a feeling of national pride, unity, great anticipation, and celebrations; I could only imagine all the emotion of a changing of power which were palpable in DC. What a great moment, but mixed emotions for me living in Tanzania, watching such a historical day for our country on another continent.

The moments building up to the swearing in ceremony were growing, more excitement, more emotion. Finally, just before 8pm, an announcement was made that the swearing in ceremony of VP Joseph Biden was to begin. There was a moment of silence and then..... darkness! The power cut out! Just as Joseph Biden was about to be sworn in.....absolutely nothing but darkness and silence. I lit a few candles and sat around and waited. And waited longer. Finally electricity returned just as broadcasters announced "And now the presidential party will leave the platform"....what a disapointment! The electrical company here, Tanesco, really dropped the ball. No one in Lindi could listen to President Obama's presidential speech! I'm so bummed.

Its great to watch the luncheon and listen to the commentary, to see all of Obama's staff and listen to his proposed agenda for the next few days and watch coverage of such a remarkable historical occasion. But I missed his inaugural speech! And apparently the Supreme Court Justice "screwed" up part of his inauguration speech. I'll just have to watch the speech on You Tube i guess......

I'm watching CNN now as the parade is about to begin down Pennsylvania Ave. I miss DC!

Only 3 weeks until I'm back in town. Definitely looking forward to returning home!

Trouble Makers

2009-01-19T06:23:00.001-08:00

In the middle of my clinic this morning, two of the COTC students informed me that there is a "special case" in labor and delivery - a "cord prolapse".

I ran over to L&D to find a laboring patient with a cord prolapsed out of the introitus about 4-5 cm and a baby in footling breech presentation. I was surprised to find a fetal heart rate, although the baby was in acute distress with a prolonged bradycardia. I called for emergency cesarian section and the patient was rushed to the OR. In the OR I "splashed" the abdomen with an antispeptic solution and started my "crash" c-section. What we found when entering the uterus were two girls weighing 2.0kg and 2.45 kg both with apgars of 9/10 sitting in breech presentation.

I finished clinic around 3 this afternoon and then passed the ward to find the baby sisters and mother doing well.

Giza

2009-01-15T08:18:00.000-08:00

Giza means darkness in Kiswahili. If you say giza, everyone generally understands that you mean that there is darkness because the sun has set or because there is no electricity and therefore no light! The latter has been the case here in Lindi the past couple of days! From morning until evening, we've had no electricity. When there's no electricity I still see alot of patients in clinic but the patient's can't get any labs drawn and can't get any imaging. If you saw the scene at the hospital today, you would have seen a ton of frustrated, tired patients waiting around for the electricity to return. Fortunately we don't loose electricity that often so on days when we do have electricity, I end up scanning a ton of patients in ultrasound.

This evening I got lucky, the power returned just before sunset. I wasn't so lucky last night. The power didn't return until around nine at night.

I took the picture above last night. I am a fan of candle light dinners; but not when I'm eating alone! Especially when I'm eating alone at home in the dark by the light of a couple of candles! Fortunately that doesn't happen too often, but when it does, its depressing!

Tomorrow is an operating day. There are a couple of laparotomies for adnexal masses and one excisional biopsy for a breast mass. I also promised the students at the COTC that I would teach tomorrow. I postponed my lecture today because there was no electricity. There is chalk and a chalkboard but I've been preferring to give power point lectures. And I can't use the projector when we don't have power.

I finally booked a flight back to the US. February 12th I'm flying KLM. Connecting through Amsterdam and then flying into Washington DC. I'll be in the States for 3 weeks! Definitely looking forward to the time home. I want to visit everyone! But its also easier if everyone comes to DC to visit! You are welcome to stay with my parents,:) sorry I don't have any permanent residence in the States these days to invite you to visit me.

Thirty-something

2009-01-07T06:54:00.000-08:00

Watching paint dry. That's about as exciting as my birthday has been today. I'm exaggerating a bit, but nothing special has happened nor have I planned anything special for my B-day. I went into work as usual this morning. I did one cervical cerclage for a woman with an incompetant cervix this morning and then I went to the clinic. Clinic was very busy today, lot of overflow from the new year's holiday. I saw twenty-two patients by mid afternoon and then scanned about a dozen patients in ultrasound. Today was UTI (urinary tract infection) day in clinic because about seven or eight patients came with a urinary tract infection. There were also a few interesting cases. I saw one woman with a very large abdomino-pelvic mass which may be an ovarian malignancy. She will have an operation next week. I saw two patients with cancer - one with a bladder cancer and another with metastatic breast cancer. I expect both patients will be referred to Dar es Salaam for treatment.

I finished work around 5 and then went home. Hadija, my housekeeper, prepared an excellent meal - baked fish, rice and vegetables. It was the highlight of my day. I am planning to celebrate this weekend. On Friday I'm going to go the popular bar Santorini with a few colleagues to get a drink or two and then I expect to go dancing at Magereza's "Social Club" after. There is always "bongo flava" music playing until early hours of the morning.....

I'm planning my trip back to the States. Hopefully by early February. Hope my friends and family will have some free time in February. I want to visit everyone. We'll see how that goes!

Sorry I don't have any interesting pictures to post today. Despite the expression on my face I am happy its my Bday but not too thrilled I'm another year older!

Welcoming the New Year

2009-01-02T06:19:00.000-08:00

Happy New Year! I spent New Year's on the beach at Santorini Bar with colleagues. We had a few drinks and then after midnight went next door to "Magereza's Social Club" to dance to some "bongo" flavor music.

The first of January is a National Holiday so I spent most of yesterday relaxing. I went into the hospital in the morning to check on a few patients.

Today was a busy day with two operations, one TAH for a woman with symptomatic fibroids followed by a vaginal hysterectomy, a/p colporrhaphy for a woman with pelvic organ prolapse. Both operations went well. There were a bunch of patients to scan at ultrasound and then I made a quick stop in the ward to check on patients.

My internet is finally back after about a week and a half of no internet because the land line was not functioning. But with luck, the one and only TTCL technician was able to fix the problem.

This weekend will be relaxing. I'm in the process of trying to plan my trip back to the States. Looks like I will be able to make it early February for three or four weeks. I hope my friends and family are going to be free next month....hint.

Happy New Year, I hope the new year is a happy and healthy one for everyone:)

AVC

2008-12-19T04:33:00.000-08:00

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

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

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

Happy Holidays, and Happy New Year!

Hamna Umeme

2008-12-10T08:24:00.000-08:00

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

Future AMOs

2008-12-02T06:44:00.001-08:00

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

Free Mangos

2008-12-02T06:36:00.000-08:00

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

No bones for you

2008-12-02T06:23:00.001-08:00

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

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

Another VVF

2008-12-01T08:28:00.000-08:00

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

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

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

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

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

A Full Moon

2008-11-29T08:43:00.000-08:00

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

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

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

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

In and around Lindi

2008-11-18T09:06:00.000-08:00

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

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

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

COTC Teaching

2008-11-11T06:11:00.000-08:00

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

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

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

Murphy's Law on Life in Lindi

2008-11-10T10:25:00.000-08:00

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

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

Celebrating victories!

2008-11-07T20:59:00.000-08:00

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

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

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

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

2008-11-02T10:23:00.000-08:00

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

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

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

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

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

Marking their territory

2008-10-22T10:41:00.001-07:00

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

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

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

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

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

Sikukuu

2008-10-14T06:21:00.000-07:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

TGIF

2008-10-10T08:16:00.001-07:00

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

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

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

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

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

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

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

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

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

Obama and McCain in Lindi, 3 weeks old

2008-10-01T06:55:00.001-07:00

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

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

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

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

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

New house in Lindi

2008-09-21T06:38:00.001-07:00

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

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

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

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

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

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

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

banana trees

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

Work, weather, life, and other frustrations

2008-09-16T06:55:00.000-07:00

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

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

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

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

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

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

Hotel Chemi Kumi and Hospitali Sokoine

2008-09-10T06:15:00.001-07:00

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

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

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

Lindi

2008-09-05T06:46:00.001-07:00

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

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

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

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

Arusha National Park

2008-08-31T05:32:00.000-07:00

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

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

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

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

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

below: Twiga = kiswahili for Giraffe

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

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

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

More Twigas

above: pair of twigas (male and female)

below: couple of hippos sunbathing out of the lake

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

below: twiga on break

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

above: pundamilia is Kiswahili for zebra

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

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

Arusha

2008-08-27T22:56:00.000-07:00

Arusha is a beautiful.... Situated at the foot of Mt. Meru (about 4500 meters), the city has the beauty of the mountains along the skyline and the hustle of city life in the city center. Arusha is only about 60 km from the Kenya border and much closer to the equator than my house in Ndanda, but the higher altitude makes the climate much different with temerperatures this time of year on the cold side! It was actually cold, rainy and windy this morning. Reminded me of fall in Chicago!

Arrived in Arusha a couple of days ago on a one hour flight from Mwanza to Kilamanjaro International Airport. Luckily for me I chose the correct side of the plane to sit on so I could see Mt. Kilamanjaro as we began the descent. The first glimpse of the mountain towering above the clouds was awesome. I took a bunch of pictures from the plane, but the flash into the window made the pictures blurry and you don't get the mountain's full effect.

From the airport I took a 45 minute shuttle bus into Arusha.

I'm staying at the New Meru Inn Hotel - rates are affordable and its close to the city center. The hotel is nice but has a hostel feel to it because there are a ton of college kids from Europe and UK staying in the 'hotel' who are backpacking around. There are also 50 or so students from UCLA here working for an organization to develop an orphanage.

Arusha is definitely the Safari Capital of Tanzania! In the city centre there are by far the most 'wazungu's' (white European's) that I've seen in Tanzania. The first day while walking around, I made the mistake of carrying a guide book, map and camera. The camera and guide book made it easy for the locals to spot me and strike up a conversation that always leads to an offer to do business or to sign up for a safari. I was frustrated by the never-ending greetings i get on the street like 'mambo rafiki' (how are you my friend) and the offers for safaris that I just started speaking in Kiswahili. I get a little bit more respect by speaking in Kiswahili, but this doesn't stop the next guy down the block from doing the same.

Yesterday I spent the day walking around the city center and along the perimeter of the city taking in the views and getting a feel for the people in the city. There are beautiful views of Mt. Meru but yesterday we had overcast skies, not great for pictures.

Received good news from my manager in Dar who yesterday confirmed that I will be starting my new post in Lindi Region next week! I'll be traveling to Mtwara on September 2nd and begin my new assignment at Sokoine Hospital as early as next Wednesday. In Mtwara, I'm scheduled to meet the doctor-in-charge of Sokoine and together we will drive to Lindi. I will temporarily be staying in the guest house in Lindi for two weeks until final arrangements on my house are made.

Ndolage

2008-08-25T03:14:00.000-07:00

The 'bugonzi?' = waterfalls in Kiswahili

Views from the cliff of the mountain looking out to lake Victoria

Bukoba pictures

2008-08-25T02:56:00.000-07:00

Sad story - the two brothers lost their mother to HIV/AIDS and father is very sick with AIDS. Older brother with rabbit is caretaker of father and his younger brother. Children are receiving aid from local NGO.

The largest supply of bananas I've ever seen. I think most get shipped out of Bukoba to other regions in Tanzania.

Bukoba

2008-08-25T02:43:00.000-07:00

Hello from Bukoba! - a beautiful city on the Western shore of Lake Victoria. Arrived Wednesday morning and had breakfast at David and Janette Cowie's (two fellow volunteers based in Bukoba) house. Wandered around the city and enjoyed seeing the other volunteers who are also based in this area of the country.
The people of Bukoba are very friendly like most of the people in Tanzania. The city has a very lively bustling city center and the market has the largest stock of bananas I've ever seen. Many of the bananas get shipped to Mwanza or other cities south of the lake. Outside of the city center there are some beautiful places to take walks - along the coast towards the pier and down one of the roads towards the airport. There are not as many wazungus in these areas but the sites are worth the trip. I spent the last night in Bukoba at the Yasila Hotel, on the beach looking out at Musila? Island. Sitting on the beach eating fresh Tilapia from the lake was definitely a nice way to remember Bukoba.

Friday I took a short road trip to Ndolage - a large village about 1 hour west of Bukoba. Ndolage has a small hospital and nursing school where Teresita Sabio - another volunteer is based as a nursing school teacher trainer.

The center of this large village has a small market and hospital and not much else aside from spectacular views from atop the mountain looking east towards the lake. From the top of the mountain you can probably see for many miles almost out to the lake.

Still have the green light to begin working in Lindi's Sokoine Hospital by September first although this date is not firm because I'm still waiting on my house and work permit renewal.
Picture taken in Ndolage at the cliff of the mountain overlooking the waterfall.

Go to my facebook page - I just uploaded a bunch of new pictures from Bukoba and Ndolage.

Mwanza - Pictures

2008-08-19T01:42:00.000-07:00

Mwanza

2008-08-17T23:04:00.001-07:00

Greetings from Mwanza, Tanzania, the country’s second largest city. Located on the southern coast of Lake Victoria in Northern Tanzania the city has some impressive views! After a very long bus ride from Dar, I arrived in Mwanza early Sunday morning. I checked into the New Rehema Hotel, took a quick shower and fell asleep. I woke up by late morning, headed to the pier and bought a boat ticket to Bukoba. My original plan was to take the 9pm boat Sunday evening which would arrive in Bukoba Monday morning. But was informed the Sunday evening boat was full so instead booked a ticket on the next boat out of Mwanza - Tuesday evening.

Left Dar Es Salaam’s Ubungo bus terminal on the Mohammed Trans at 6 o’clock Saturday morning. The trip from Dar to Mwanza took a total of 20 hours! We had one 'layover' in Nzega, Tabora region. I was expecting to spend 14 hours on the bus as the bus line manager informed me when I bought my ticket, but somehow we ended up spending an additional 6 hours on the bus!! It took longer to go from Dar Es Salaam to Mwanza than it took to fly from NY to Dubai and Dubai to Dar Es Salaam combined!!

After a shower, nap and some food, I was back to feeling functional. Spent the day yesterday wandering around town and taking in some of the scenery.

At first I walked around the city center. Aside from a couple of new modern buildings, the city doesn't have any more appeal than Dar Es Salaam. There are wazungus although most are in transit between Bukoba/Uganda and either Dar or Arusha. I ate most of my meals at the Kaluna Pizzeria where most of the other wazungus eat. Spent one day walking east along the lake. There is a small town on the east bank of the lake that has a huge fish market. I thought I would see a couple of other wazungus but this was not the case.

Tonight I'm taking the 9pm boat to Bukoba to stay with some other VSO volunteer friends who are based in Bukoba. Hopefully I'll post some more pictures. The internet cafe here is twice as expensive and at least twice as slow as the one I'm used to in Dar!

Picture above: View looking north out to Lake Victoria, from the New Rehema Hotel

Back to Tanzania

2008-08-08T08:52:00.001-07:00

Its been a while since I last blogged!! I almost forgot the joy in waiting forever for my images to get uploaded:)

Well I returned safely back to Tanzania yesterday. As most of you know I had been in the U.S. for the last 3 weeks. I had a wonderful time at my sister Ellen's wedding. Congratulations to Ellen and David who are probably sipping Mai Tai's in Maui right now:)

I am so happy for my sister and I'm so happy to have been able to make it to the wedding to see family and friends and to meet most of the people who actually read this blog!! Great to see my cousins Jeff and David! And to see my parents friends after such a long time and meet new ones who work at Channel Nine or who flew into DC from Boca to go to the wedding. It was great to share some stories with you! And most importantly to know that you are still reading my blog. Its heartwarming to know that even people I had met for the first time actually really appreciate the work that's being done.

The entire wedding weekend was great. Loved seeing family and friends again and meeting many new people including David Levin's (my new brother-in-law) family. But especially enjoyed two golf games (thank you Stan Levin for setting up golf at Westwood). I'm sorry I didn't bring my A game. And thank you Rob Ades!! for the golf game at Woodmont! I played a little bit better at Woodmont but sadly my short game had suffered while I was away. Who would have guessed!

Things here in Tanzania started off a little bit shaky. Had a bit of a scare yesterday as my checked luggage did not arrive, but fortunately everything arrived today as I just returned from the airport (again). The flights were comfortable. 13 hours to Dubai and then 5 hours to Dar Es Salaam. I'm staying in the same hotel - Econo Lodge, which is located in the city center and has affordable prices (although they did hike up the price by 10% since the last time I stayed).

My program manager in Dar Es Salaam confirmed that I will begin working at Sokoine Hospital in Lindi probably beginning the first week in September. I am still waiting for accomodations to be finalized and because I have switched placements and now working in a different 'region' I am awaiting a new working permit - which should not take too long. The accomodation is the limiting factor - timewise.

As far as the work goes I will again be working as one of very few doctors in the hospital, with focus on strengthening the ob/gyn departments, reducing neonatal and maternal morbidity and mortality, as well as part time teaching of clinical officers.

My work probably won't start again for another three weeks, but I 'm glad to be back in Tanzania and looking forward to traveling around a bit before starting work again. Considering a small trip up north to Arusha or else south to Cape Town, South Africa.

I will still be using the same emails (nhorlic@aol.com) and neil@ndanda.net so please email and stay in touch!

The pictures were taken in Lindi (a larger city compared to my previous home in Ndanda), located right on the Indian Ocean. The first picture was taken right on the coast and the bottom picture of one of the side streets in town.

Goodbye Ndanda

2008-07-01T07:35:00.000-07:00

So much has happened in the last month (since I last "blogged").....many good and some "interesting" experiences. Because of the interesting experiences I've decided I want to change my placement location here in Tanzania. To make a long story short, a couple of things didn't work out as I'd liked, so I've had discussions with my program manager in Dar and in process of making arrangements to move to a different hospital, relatively close to Ndanda.

And I've been finalizing travel plans.....Will be arriving in the States on July 17th and staying for 3 weeks. My sister Ellen is getting married to her fiance David, August 3rd! Looking forward to the wedding! Also will be in NYC for one weekend to visit friends and in Chicago for a couple of days as well.....

And then I return to Tanzania August 7th...... and if all goes according to plan, I would start work in a different hospital when I return.......

So, I will be changing email addresses and likely changing the website address (no longer travelingneil.blogspot.com...... I'll make a new post and inform of the website name change)......

In the meantime I'll still be using the same email address.

The other day I enjoyed a very heartwarming goodbye party hosted by the nursing staff at Maternity department. See above picture. The nurses sang me a song (7 minutes) which I was lucky to capture on video to show you and save for memories...... The video is worth more than a thousand words so I'll have to show to you in person for full effect. (Song is sung in Kiswahili but I can translate). I think if you listen to the song now, the only word you might recognize is Horlick :)

Time seems to have flown by. Its now July 1st. I have to start packing and will move out of my house by July 11th........will be in Mtwara for a couple of days, then Dar es Salaam a couple of days and then my flight leaves for the states on July 16th! I'm definitely looking forward to coming back home for a short vacation and seeing family and friends! And to eat a little (or a lot) of sushi!

Until next time, hope all is well back home and I'll inform of my new email address and website blog name. But in the meantime can you help me think of a new website name??

Goodbye Sheena

2008-06-01T07:35:00.000-07:00

Sheena, our labarotory technologist from Colorado left to go back home to the States today. After living in Ndanda for 20 months, she packed her bags and boarded the Precision Air flight to Dar Es Salaam this afternoon.

Its a sad day for me - not only is our most reliable source of accurate lab tests gone, but now I'm the lone American living in Ndanda!

Immediately after returning from the airport to drop off Sheena, the hospital administrator approached me with a bottle of Heinz 57 Ketchup (maybe in an effort to appease me after all the joking about the dutch and their mayonaisse).....

Soon enough a replacement lab technologist will arrive (end of July) from the Phillipines.

We arrived in Mtwara Friday night about a quarter past 6 just in time to take this photo of the sunset on the Indian Ocean. 2nd picture taken this afternoon on a lazy sunday afternoon watching sailboats and dhows pass by the guest house. Below is a picture from Saturday night farewell dinner for Sheena at the Old Boma Hotel. About 12 of us sat poolside and had buffet dinner and wine. Now I'm back in Ndanda and going to head to the guest house for dinner soon. Hope all is well back home!

Name That Movie

2008-05-21T06:28:00.000-07:00

OK I'm offering 500 Tanzanian Schillings to the first person who can name this movie....I watched last night.

As you can see, the white wall in the house makes for a nice movie screen from which its possible to project movies.

Wednesday is teaching day.....another lecture for the nursing students - today I gave a lecture on "Obstetric Hemorrhage". It is the first time the students have received any "clinical" lectures so sometimes I find it difficult to gauge their level of knowledge. But with an average test score of 50% either teacher or students are not doing so well!

Tuesdays and Fridays are now "operating days" - so any gyn cases that need to go to the OR go on Tues or Fri. Yesterday we had two laparotomies for adnexal masses - first was a 40 year old with large adnexal mass probably mucinous cystadenoma. Second was a postmenopausal female with large adnexal mass - turned out to be a dermoid cyst - probably she had for a few decades.....

Weather here has been beautiful last few days with lower humidity. Seems like the rainy season is behind us. Need to spend more time outside and back to the mini lake (Chemchemi) here for swimming.

Hope you are having more seasonable weather back home!

The Market

2008-05-15T07:05:00.000-07:00

Almost all prices for goods in Tanzania are negotiable. There are exceptions like business products sold in Dar Es Salaam, however, almost anywhere else, you are expected to negotiate. Nowhere else is this more true that at the market. Today was no exception.
I just returned from the market to buy a few things, some fruits and vegetables, cooking oil and flour.....and just as always, I have to negotiate with the same vendors I see everyday.
But things are getting worse. I mean each time I go to the market more peoople approach me with items to buy and each is looking to sell me something for an inflated price.
Today the same thing happened. I rode my bike down the street to the market. The first person who saw me began shouting "Doctor, Doctor" and ran up to me with a handful of oranges. The greeting was heard by a bunch of other people who took it as a sign to draw near as well, and within minutes I was surrounded by at least a dozen people with fruits and vegetables, toilet paper, tooth picks, watches, shoes, etc. all yelling and screaming to buy their items.....
Today was a little bit different, there were more people, maybe 15 total, all urging me to buy something. Being a white guy in the market here, the locals know that they can inflate the prices on everything. And as much as I know it is a higher price there is no way to bargain! So I get all of my essentials and give the loudest person money. Next time I need to buy something I'm going to make a list and give to one of the nurses.......

I gave my nursing students a quiz today - just a simple 12 question test on anatomy/physiology of reproductive system. I asked the students after, what they though of the questions and most said that the questions were easy......The average score was a 50%, the highest score was 10 correct and the lowest was 2 correct. It was the first quiz I've written, so I tried to balance hard, medium, and easy questions! I included questions like name the largest artery in the body to questions differentiating between hormones involved in HPO axis......interestingly enough, one of the students who scored the highest, missed the answer to largest artery in the body!

At night its been quiet as usual. It helps having the projector that I bought in Dar es Salaam - the last few nights my neighbors have come over for a movie, popcorn and wine; we have been watching Godfather (part II last night)......

That's it from here. If you can think of any suggestions on how to improve test scores in Tanzanian nursing students let me know!!

Mother's day

2008-05-12T05:48:00.000-07:00

Happy Mother's day!

Today was "Nurses day" - so all of the nurses are scheduled to work their normal duty hours but find time to ask all of the doctors for gifts! or money.....
It was busy today..... Started the day with an elective repeat c-section for twins at term with one previous c/section. Both male babies with good outcomes. Then another c/section for twins due to prolapse of the cervix and obstructed labor. Both male babies with good outcomes. Then had a ruptured ectopic. Tomorrow should be another busy day with a scheduled repeat c/section and TAH.

Hope you are doing well back home. Sorry to hear about the unseasonably cold weather in DC and Chicago! Its been in the 30s all week here....but in Celcius, so I can't complain!

Teaching

2008-05-01T00:41:00.000-07:00

Started teaching the nursing school students yesterday! From 12pm to 2pm I gave my first lecture - "Anatomy of female reproductive system".

When I walked into the classroom it was difficult to keep a straight face because all of the students (twenty) stood up and greeted me as I made my way into the classroom.....something perhaps American students should do too? :)

Every lecture is preceded by a prayer and then greetings between teacher and students.

Luckily I prepared enough information to teach for 2 hours though this was difficult.

I took before and after pictures of my class to see if you can identify how many students were sleeping after the lecture, but I was happy to see only one student nodding off at the end :) So I agreed with the principal to give lectures to the second year students once a week for 2 hours.......it is a little bit of work to prepare the lectures but a great review for me and fun to teach these students!

Maternity Staff

2008-04-24T11:11:00.001-07:00

Outside of L&D with the best nursing staff in Tanzania! (aka the maternity nurses at St. Benedict's Hospital Ndanda). From left to right: Sabina, Sofia, Reinfrieda, Cecilia, and myself.

Photo taken while I was on call earlier this evening. Its nice to be back in Ndanda after brief break in Morogoro.

Yesterday had two c-sections (first a repeat, term with CPD, second an emergent c-section due to cord prolapse). Today had two gyn cases, a ruptured ectopic followed by exploratory laparotomy, RSO for large pelvic mass.

Kwa Heri Morogoro

2008-04-24T10:45:00.000-07:00

Group picture taken on last day of Intermediate Kiswahili language course in Morogoro. From left to right - myself. Mama Jenga (teacher), Teresita nurse teacher, Benji (teacher), Chandrika, business advisor, and Corrie gynecologist.

Morogoro sites

2008-04-09T06:33:00.000-07:00

More pics from Morogoro! From top down 1. little children along the road close to the accomodations 2. Bus station 3. city center and dala-dala station 4. uluguru mountains

Kiswahili class from 8am to 3pm today. We are eating out tonite - some are going to the Dragonairre restaurant and then all to Acropol - for dinner.

By the Riverside

2008-04-08T06:48:00.001-07:00

Greetings from Morogoro! Arrived yesterday and started intermediate Kiswahili language training today. Feels like deja vu because we are staying at the same "hotel" and following the same language schedule.

There is a small river that runs through Morogoro which I cross to get to town. It seems like this is one of the best videos of Morogoro on "You Tube" that is short and easy to view....

Dar es Salaam street and beach scenes

2008-04-06T06:31:00.001-07:00

Greetings from Dar! Just arrived this afternoon after a one hour flight from Mtwara. Checked into the Econo Lodge hotel and then grabbed a bite to eat at Chef's Pride Restaurant across the street. Taking a bus tomorrow to Morogorro for 10 day intermediate Kiswahili Language class. This time it will only be 5 of us (some of the other "vols" either left or decided they don't need intermediate training).

Looking forward to returning to Morogorro and taking a short break from the work at the hospital. I tried to upload this video from You Tube but seems to be having problems

Watoto Wamefurahi

2008-03-24T10:34:00.001-07:00

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

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

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

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

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

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

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

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

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

City slickers, part two

2008-03-18T09:08:00.000-07:00

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

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

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

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

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

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

Baby Steps

2008-03-12T08:59:00.001-07:00

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

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

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

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

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

10 degrees South

2008-03-09T09:02:00.000-07:00

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

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

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

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

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

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

Hurry up and wait

2008-03-06T04:15:00.001-08:00

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

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

Good Read

2008-03-04T05:44:00.001-08:00

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

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

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

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

A new look in Africa

2008-03-03T10:39:00.001-08:00

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

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

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

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

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

5 months

2008-03-02T10:30:00.000-08:00

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

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

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

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

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

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

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

Escargot?

2008-02-25T05:02:00.000-08:00

I had to work the OPD (outpatient department) today because my coworker unexpectedly announced that he has meetings this entire week in Masasi (neighboring region) for the secondary school here. There is something fishy about this sudden revelation....

I don't particulary like working in the OPD because all patients are seen here (sort of a triage spot) - everything from orthopedics to peds/medicine, etc. and I don't particulary gain any experience in triaging ortho cases. So I send all of the male patients that are not straightforward to the theatre for the gen. surgeon to give a final disposition. I think I saw 50-60 patients. They are sometimes quick triage visits othertimes a full exam. The toughest part is trying to pretend I understannd the entire history in Kiswahili......I still believe that the people in southern Tanzania speak with an accent that is difficult to understand - sort of like southernerns in the states? I did not think I would get a break from the continuous stream of patients; however, I stepped out around noon for some tea and bagia (fried okra I think) and peanuts. I was back in the OPD until 2:30.

At 2:30 we had a meeting to discuss the 2nd maternal death of the year. This death was in a 28 year old mother about 23 weeks pregnant with HIV who was admitted with palpitations, fevers, and dyspnea. She died about 4 days after her admission. The CD4 count was 354, which is generally above the level at which ART is started. I found out about her death while I was on call on Saturday right after leaving the theatre for splenectomy in a 8 year old boy who fell down from a mango tree. (When there is an emergency trauma case, the gen. surgeon gets called and then i assist). I saw another kid up in a tree as we were taking this boy to the theatre. Don't know if he made it down safely or not.

BTW the first maternal death was a transfer with postpartum sepsis, severe malaria and severe anemia after delivering IUFD (intrauterine fetal demise) at an another hospital. She was only about 22 years old but had multiorgan failure. Very sad case.

Aside from the splenectomy, Saturday's call was relatively quiet. I was hoping to be in Mtwara for a weekend free, but was not given permission by the gen. surgeon because I was told I had the previous weekend free and we are supposed to only have one weekend a month free. Don't ask me how my colleague can unexpectedly get a week off to go to a meeting in Masasi but I could not switch calls to get a weekend free.

Anyone like escargot? Referring to the picture above. I have to explain. When I'm on call I have to hope that I don't get called to see patients around 6:30 becuase that is when dinner is served in the Abbey guest house. Murphy's Law was the case this past weekend. Twenty minutes beforfe dinner, I got a call from the male surgical ward to see two patients - a ruptured spleen and a ? inguinal hernia. So of course I was running to see the patients so that I could make it to dinner on time when I stepped on my slow-moving friend above - a crack of the shell and a pile of yellow sludge later, I was down in Ward 2. It seems that its snail season nowadays with snails/slugs all over the place. Add some garlic butter and chicken broth and call it escargot? Actually I would have preferred to scoop up the pile of sludge and cook to add some variety to my meals because lately my diet has consisted of mystery meat, tomatoes and rice.

If you sense a cynical tone in this post, I think you are right, I do too. Its because I'm still frustrated by my banking issue. Its now been 2 months since I deposited my predeparture check from VSO but still hasn't cleared. I say "hi" to my "friends" in the bank almost every day to ask if my check has cleared. "Bado" they say = "not yet" I was expecting this response again today so I refused to leave the bank until they gave me the telephone number of the boss in charge. I have emailed Canada to ask them too. Hopefully somehow the check will turn up and clear. Right below good food and family/friends I think efficiency of banking systems ranks #3 on my list of things I miss from the US :)

Miso Soup

2008-02-16T09:55:00.000-08:00

Just back from dinner. Was invited to Irina's house for a Japanese dinner. Irina is a JICA (Japanese International Cooperation Agency) Volunteer based in Ndanda working at a secondary school teaching chemistry. Along with the other VSO volunteers, we met up with Irina and Mickey another JICA, IT volunteer to eat Japanese food - fried rice, miso soup and meat with potatoes. Chocolate cake and a sort of pineapple jello dessert. Tanzanian beers served for beverage. V. Good meal.
I was on call on Thursday night (valentine's day). It was relatively quiet. There was one call from the male surgical ward around 6 pm to see a pt with a "Mamba" bite.....I read the chart and saw "mamba" bite, looked at the patient with a huge gaping wound in the posterior thigh and then soon enough learned that Mamba is Kiswahili for crocodile. Needless to say it was the first crocodile bite i've seen. Forget about management. Just brought the patient to the theatre for wound cleaning. A few smaller lesions could be sutured. I gave pain meds and antibiotics. Was not expecting to be looking at the posterior thigh muscles again after gross anatomy first year of med school. The young kid was swimming in the local river and came with severe pain and bleeding of his thigh after a crocodile bit him. Apparently it was not even the first "mamba" bite of the year.
The rest of the call was quiet except one patient returned, a readmission for post menopausal bleeding. Biopsy last month came back as cervical squamous cell carcinoma. She is at least a stage III with pelvic side wall involvement. She needs radiation so she is referred to Ocean Road hospital in Dar Es Salaam for further management.
This weekened is my free weekend. The plan was to go to Mtwara for R&R and snorkeling but found out about 15 minutes into the drive that the guest house was already fully occupied. We had to turn around and head back to Ndanda. I was a little disappointed but at least we found out soon after we departed. Maybe next week I can switch a call and make it to Mtwara.
That is it from here. Hope you have a good weekend.

Weekend

2008-02-11T07:13:00.000-08:00

It rained most of the day yesterday. We got a brief downpour and then a steady light mist....its cooled things off, so its not as humid.
I was on call yesterday. Early start with a repeat c-section (prior c-section x2 in labor).
Around noon, I had another case of trauma to the head with a scalp laceration that needed suturing.
The rain picked up by mid afternoon. I thought would keep patients away.....got a call from male surgical ward to see a 21 year old who fell off his bicycle while riding downhill. Apparently lost control because of the slippery road and fell on his knee. He had a compound distal femur fracture, that required emergency traction/repositioning. I called the general surgeon; Emergency turned into a wait of about an hour before the "theatre" nurse arrived with the key to open the doors to the OR. At least I was home by 10 and ready to call it a night.
Read a little bit - "The famished road" - very interesting read by an African author, Ben Okri - surreal fictional story of a boy living in between a world of reality and spirits. I fell asleep reading only to be woken up by ward 6 calling to see a woman who came in after a physical assault by her husband with bruises to her eyes, and pain and swelling in the ribs. She's admitted for safety, pain control and for xrays to rule out fractures today. And I'm not sure what the policy is regarding reporting domestic violence. Back home and switched the lights off only to get another call about 15 minutes later again from the female surgical ward to see a woman who came in after falling down in her house. She smelled heavily of alcohol and had minor bruises to her arm. Disposition - to home with brufen, avoiding further alcohol.
The rain stopped by this morning, leaving overcast skies, and a cooler temperature. I had a scheduled repeat c-section this morning, followed by laparotomy for pelvic mass that revealed a pyosalpinx, peritonitis and appendicitis. The outpatient department was relatively quiet, so I was back home by 3.
I stopped by the bank to see if my check had cleared after depositing a predeparture allowance from VSO back in December. "Bado" I'm told (meaning not yet). At first I was getting angry and frustrated by how slow the bank and postal service operates but by now I think I've become a little more patient. We were taught by our Kiswahili teachers in Morogoro "TIT" meaning This is Tanzania - an accronym that they (Tanzanian's) use when service is slow!

Dinner

2008-02-02T10:42:00.000-08:00

Ndanda's entire expat community (aside from the members of the Benedictine church) met again for dinner tonite. The four of us sat outside the back of our houses and ate dinner - meat, gnocchi, salad and tomato soup, with a lemon cake for dessert..... Very good meal. Topics of discussion - current events - politics (US and international),....The events leading up to Super Tuesday is getting a lot of attention among the Tanzanian's.....One lab assistant asked today "Do you think Mama Clinton will win the election?" Last night while eating dinner at the guest house I over heard some Tanzanian's asking each other "do you think America is ready for a woman president?"
And re the violence in Kenya....seems that hopefully things have quieted down a little bit for now. I had never realized how "tribal" the country is and has been for a while. I heard one of the doctors working in Mtwara say that in Kenya even now, some doctors of one tribe may refuse to treat patients from another tribe....
Super bowl Sunday tomorrow - I had almost forgotten about it; do the Giants have a chance?
I don't know what the spread is but seems like New England is heavily favored? Correct me if I'm wrong.
I'm on call again tonight. I switched calls w/ my colleage because he had to go to the neighboring village for a meeting today; On call again tomorrow. Its been quiet so far ("Knock on wood").....
Going to try to sleep now while its quiet. Have a good weekend!

Mikindani

2008-01-27T06:46:00.000-08:00

Very enjoyable weekend in Mtwara!

We arrived in Mtwara Friday evening and had dinner with a Dutch couple who are good friends of my neighbor and in Tanzania visiting. Both are doctors and just finished spending 6 months in southern Sudan working for "Doctors of the world". It was very interesting to hear their perspective on work/life in southern Sudan and to compare notes on different NGO's.

Saturday evening was a treat! We drove into Mikindani, a short drive just north of Mtwara along the tarmac road. Mikindani is an old trading port that used to be the main port in the southeast before the development of Mtwara. We ate dinner at the "Old Boma" an old hotel built in 1859 that has magnificent views of the Mikindani bay and Indian Ocean. We met up with a few other volunteers who are placed in Mtwara. Before dinner walked through the town of Mikindani, and then relaxed in the hotel while the buffet was being prepared. Excellent food, wine and company....

Lazy relaxing day today. We skipped snorkeling because it was overcast and very windy, tough conditions for seeing the aquatic life and coral well....I layed out on the porch with a book and my ipod.

I'm reading "Africa - A biography of the continent" right now. Very interesting - Mostly an account of the history of the continent from an evolutionary point of view covering a huge time period, essentially from the beginning of life up to recent events.

I don't go to Mtwara that often (perhaps once a month) so I find taking in the landscape and peope living in the nearby villages very interesting. There are many small villages scattered about along the tarmac road. And in between villages are thousands of acres of thick bush, with dense forests of palm trees. It is easy to imagine dinosaurs or the earliest mammals roaming throughout the terrain. It is a very surreal feeling, kind of like traveling back in time hundreds of thousands of years ago. Of course this is where life began and the evolution of humanity took place! It is interesting too to observe how people live; I imagine not much has changed (in terms of individual lifestyles) since humans evolved and became hunters and gatherers, because most people in southern Tanzania are substinence farmers living off the land.....

Its back to work tomorrow and on call on Tuesday. Hope you had a nice weekend!

Stone Town

2008-01-22T11:03:00.001-08:00

A few more pics from Stone Town, Zanzibar.

(From top down - 1. View from Archipelago's, a popular spot for brunch among Wazungu's (European/Expats) 2. View from dinner table along the beach. 3. Another shot from the table along the beach. 4. Congestion in one of the many narrow alleyway streets in stone town. 4. Approaching one of the larger markets from the main road).

Black cloud

2008-01-21T00:08:00.000-08:00

I'm beginning to think I'm a black cloud when it comes to trauma cases because I only get called from the male surgical ward in the middle of the night. Last week I ended call with a stab wound to the lower abdomen, evisceration of small bowel. The other night two patients came in just after I fell asleep around midnight - stab wounds to the head and arms. For a country that is relatively peaceful there sure is plenty of violence (at least in Southeastern Tanzania during the middle of the night).

I took this picture the other day while walking back from dinner just before sundown, reminiscing about my last call night suturing scalp wounds in the theatre...Once the sun goes down the clouds do look a little black :)

Lindi

2008-01-17T04:47:00.001-08:00

Took a day trip to Lindi last Sunday. Lindi is the largest town along the coast between Dar Es Salaam and Mtwara. Although nowadays Lindi is known to be a relatively quiet, "sleepy" town. The town center has many old colonial-era style buildings which look like they have been unoccupied for many years....
We wandered around town for a while. Not many restaurants or shops, but found one good restaurant that served kukuu na chipsi (chicken and fries).
Spent the afternoon at the beach (sorry Chicagoans reading this in freezing weather). It was too hot for sunbathing and low tide was too low for swimming. Most of our group fell asleep in the shade under a palm tree.
It was definitely a worthwhile day trip but I don't think I'll be going back to Lindi any time soon.

Donations

2008-01-11T09:32:00.001-08:00

Call day on Wednesday was interesting. Started with a ruptured ectopic, then a c-section for obstructed labor. A D&C followed for retained placenta. I was back home resting by 1pm as usual. The call night itself was quiet until about 2am. I came to Maternity to assist in delivery. When I arrived the patient was complete and pushing. Review of the partograph showed entirely normal fetal heart tracing. Routine episiotomy cut b/c of tight introitus. Pt delivered with severe shoulder dystocia, nuchal cord, and terminal meconium. The baby died within 5 minutes after delivery.

Fetal heart tone monitoring in L&D uses Pinnard Fetoscopes, frustrating for me because documentation of short/long term variability is impossible. Frustrations continue. I've decided to publish wanted, classified ads in professional OB journals for used/old CTG/CEFM machines. Must be someone willing to donate to the hospital here. In the meantime I'm waiting for dopplers to arrive from Dar. Postal service operating very slowly this time of year!

Tomorrow is a Sikuku (holiday) here, no work. Going to relax tomorrow. Dinner with the neighbors, assignment to prepare a salad. Can't screw up salad, I think.
Sunday taking a day trip to Lindi, one of the larger near by cities on the coast. Maybe some snorkeling and wandering about the city for a while.....

Another picture of Stone Town, Zanzibar....many more to come.
Hope all is well back home.

B-Day, January 7th

2008-01-08T09:47:00.001-08:00

My B-day was pretty uneventful:( (January 7th - in case you forgot:).
I went to work as usual and then had dinner at the Abbey Guesthouse. Eggs and rice :( pretty pathetic b-day dinner. After dinner I had a couple glasses of nice wine but then developed a bad headache:(....
It was the first time I've celebrated my B-day in the middle of the summer.... and in 30 degrees (celcius:)!

The picture is from Zanzibar....I'm hoping one day I can upload the rest of the pictures, and not go over my internet limit!

On call tomorrow again. Getting into routine here which is nice. Non-call days i am done by 3/4ish and on the bike and swimming by 5. Nights are very quiet! Have to find new books to read or new DVD's to watch.

No travel plans in the near future. Neighbors are going back to Dar in a couple weeks for a conference for volunteers who have been here over a year.....

first blog of 2008

2008-01-04T07:58:00.000-08:00

Hope your new year is off to a good start....any new year's resolutions?

The picture is from the coast of Zanzibar, taken from the dinner table at a restaurant on the beach. Hoping to upload the rest of the pics from Zanzibar soon, I can't on my laptop because I'll exceed my internet limit of 100MB and end up paying my months salaray again....

Its been back to work this past week. Got tested for Malaria yesterday b/c feeling a bit feverish and fatigued but had a negative result. Probably viral syndrome. Feeling better today. Biked up to the pond and swam for half an hour today....then just returned from dinner at the Abbey. Today we were served meat and rice. The other night we had pizza (surprisingly good).

At night I find myself either reading or watching DVD's. Its safe to say there is almost absolutely nothing to do here at night. In the last few weeks I've watched 3 seasons of "Prison Break" about 44 episodes (its addicting....) and now i'm in the middle of reading a couple of books....."The state of Africa" and "Footprints of God"....The first a very detailed history of Africa, before and after independance....and the second an interesting sci-fi book that made its way around Ndanda.

That's about it from here. I am on call tomorrow night.
Sunday we have a "Secret Santa" party with the nurses. I had to spend at least $5,000 schillings to buy one of the nurses a present. Someone unknown to me to do the same and then exchange on Sunday. Monday of course is my B-day. No special plans as of yet.....

Happy New Year

2007-12-30T00:39:00.000-08:00

The interntet's been down for the past few days. When we arrived back in Ndanda, a bad storm passed. Thunder and lightning struck one of the computer lines. IT department seems to have it fixed.

Work was busy the last couple days - went to theatre for another ruptured ectopic pregnancy, and a couple of c-sections. One molar pregnancy presented and had uterus evacuated.

Tonight's agenda - Party at the abbey - told to bring instruments?? Expect to be singing (or at least listening to music).
We are planning a new years eve dinner here, everyone's pitching in to make some pasta, i'm bringing the alcohol.

The pictures from Zanzibar should be up in a few days...

Hope everyone is doing well. Happy New Year!!

All the best for 2008!

Best wishes,
Neil

Zanzibar

2007-12-25T04:56:00.000-08:00

Zanzibar is awesome! Friday morning took an early morning ferry from Dar Es Salaam to Zanzibar. Disembarked from the boat and walked across the street to find myself surrounded by what seemed like thousands of people buying/selling items in the markets that fill the maze of narrow winding streets that make up Stone Town. After a little shopping i checked into Maruhubi hotel a short distance down the road and spent the afternoon swimming in the pool with a few of the other VSO "volunteers". More of the same on Saturday and then went for dinner at a little more upscale hotel Mtoni Marine's to celebrate on of the vol's 50th birthday. About 12 of us sat out on the beach under the stars listening to a few Tanzanian's play local music and then sung happy birthday to Corrie. The next day I took a taxi across the island due west to the town of Uroa to meet Sheena, Francijn and Diane, my next door neighbors in Ndanda who were staying at a little cheaper hotel on the east coast (Santa Maria Coral Park). This hotel is very quiet, secluded hotel with little cabanas scattered about the beach. There is a beautiful beachfront view of the Indian Ocean. We spent one afternoon snorkeling and the other days swimming in the ocean during high tide and relaxing out on the beach.

I was feeling a little ambitious with my photography and decided to take the camera out into the ocean with me to capture the amazing blue colors of ocean against the horizon. I was in the midst of telling myself to be careful not to drop my camera because there are many hidden rocks covered in sand which are not visible under the water. The next moment I tripped over the rock and found myself searching the ocean floor for the camera! Unfortunately with high tide, and sand covering the ground it was impossible to find.
There is a village on the coast and a couple of locals were out on the shore. I mentioned that I dropped my camera into the water. One man told me to wait until low tide and then look. I searched a little more without luck, and when I looked back on shore, more people in the village had come out of their homes and into the water to look for the camera. I offered 50,000 shillings to the person who could find the camera. I told the people of the village I would return just before sundown. I walked back to the hotel and saw about 50 people(men, women and children) in the water on a hunt for my camera! I returned to the village just before sundown and a little boy told me a little girl had found the camera. I walked into the village and met the girl who gave me the camera. I was surrounded by the people in the village and then I gave the girl the money. The next moment it seemed like the whole village began shouting and cheering - Of course the camera was broken but I felt that giving the money to this girl and seeing the joy on her face was worth it - I thought it would make a nice christmas present to many people. I lost a lot of pictures of the hotels and beach but I bought a new digital camera today in Stone town and have taken plenty of photos of stone town. I will download the pictures from stone town and my friends' pictures from the resort when I'm back in Ndanda. Happy Holidays!!

Post AVC

2007-12-19T07:18:00.001-08:00

Returned from "AVC" (Annual Volunteer Conference) this afternoon, very interesting meetings... See Photo Gallery for some new pictures.
Tomorrow is a bank holiday here, most of the shops are closed. Luckily made it back in time to go to the medical supplier to buy doppler ultrasounds. Tomorrow going to buy ferry tickets for Zanzibar and then probably wander around a bit. Hope everyone's doing well.

Dar

2007-12-17T09:40:00.000-08:00

Back in Dar Es Salaam for AVC (Annual volunteer conference), a 3 day conference for meetings and sharing placement experiences. The Beachcomber Hotel is host to this years VSO Tanzania conference, attendance of ~ 70 people. Located right on the Indian Ocean with spectacular views, nice pool and conference room. Just finished dinner buffet. Entertainment tonight - "African night" theme.....instructions are to wear traditional African attire (for me that means polo and kackis:). More meetings on the agenda for tomorrow and Wednesday. Thursday is a free day so i'm hoping to buy some doppler ultrasounds for the hospital and do a little more shopping in Dar. Leaving for Zanzibar on Friday to celebrate Sikuku (Christmas holiday). Expect to have plenty of pictures to share when I get back to Ndanda, maybe I can post while in Zanzibar, but not on this computer - connection is too slow.

Hope everyone is well back home.

Internet

2007-12-10T04:56:00.000-08:00

This post has to be very short and to the point. Partner hospital in Ndanda provides 100MB/ month free internet. Surprise phone call from the hospital administrator informed me that I have used 750MB the first week of December (1/3 of entire hospital MB). The extra internet equals my month's salary!

Aside from internet, have been busy with work. Was on call last Thursday and had another ruptured ectopic. She came around 9pm, with classic signs - acute abdomen, CMT, and free fluid in the pelvis. Went to the OR for salpingectomy. I'm surprised how many ectopics I see here, although not quite as surprising considering prevalence of PID is high.
Today was another busy day - TAH/possible Myomectomy on the schedule. The patient was thirty four, never pregnant and desired fertility, she had symptomatic fibroids, so I told her I will try to do a myomectomy - she had a large pedunculated 18 week size uterus, and a few smaller intramural fibroids; removed large pedunculated fibroid. Hopefully she can become pregnant. I saw a couple outpatients after that then the word from maternity came that there was a c-section for obstructed labor. I was told she came in labor and made it to complete but could not push. I did the c-section, unfortunately the baby had apgars of 0,0! probably chronic hypoxemia! I have to review the chart and see what the problem was.
Heading to Dar Es Salaam on Sunday and then to Zanzibar for holiday next week. Will take lots of pictures. Hope everyone is doing well back home.

Tanzania

2007-12-05T11:53:00.001-08:00

Karosho

2007-12-04T10:17:00.000-08:00

Call night on Sunday was not too bad. I had one c-section for CPD. The mother was a G6P5 (5 children - all born by normal vaginal delivery). But this baby did not want to deliver - suspected asynclitism. The night was quiet after that. Only a couple of patients before. Got called around 10am to pronounce the death of a man in the male surgical ward. 63 year old s/p motorcycle accident.
Today it was not too busy, apparently December is a light month for surgeries and deliveries, I guess partly because many patients don't have the money this time of year and just don't deliver now. Almost all of the patients rely on their farming of cashew nuts (karosho) to earn a living. One of the nurses asked me to buy some, so I bought a bag for $5,000 schillings (a little less than $5). They taste pretty good, very fresh.
Yesterday, I was post call. After morning conference went to round on the patients in maternity. Then one patient sent to W8 for evaluation. First trimester pain and a little bleeding. Tried to take her by wheelchair to the theatre to do an ultrasound but en route her head fell backwards and eyes shut, so we rushed back to W8, took vitals, placed a line and did a bedside ultrasound there. Was pretty confident by the exam/ultrasound she had an ectopic pregnancy. Went to OR for laparotomy and found ruptured ectopic (two this week). Again ~ one liter of blood in the pelvis...
One of the volunteers working in Mtwara is here visiting for a few days. She is from the Phillipines and is a lab tech, actually has a masters in blood transfusion services (?). She is working in a gov't hospital in Mtwara - where staff, support, supplies are not as good as Ndanda. She is leaving to go back home early (in April). Just came to visit the lab here. We had dinner last night with her, Mr. Piet the hospital administrator and two of the volunteers here - Sheena and Diane. Gnochi, and salad, one of the first good meals I've had in a long time. I asked Sheena for the recipe, maybe I can add some variety to my meals.
Received the first package from the states the other day - what an ordeal. I went to the post office about half a dozen times because they are very specific about documentation. First the package had not arrived, and when it finally did, I needed to get a key from the hospital warehouse and an "authority card" from the hospital administrator..... The post office was reluctant to give me my package, but I insisted that I have received authority and work for the hospital and need to get back to my duties......(it took about 3 weeks to arrive - about a week to get to Tanzania and then about two weeks from Dar Es Salaam).
Hope everyone is doing well at home. Remember you can visit me in Tanzania whenever you want......except for August - Ellen is getting married! Scary to write let alone think about (Congratulations David and Ellen).
Another couple of weeks in Ndanda before my 10 day holiday in Dar and then Zanzibar - which I'm definitely looking forward to....

Out of Africa

2007-12-01T13:13:00.001-08:00

Video Soundtrack

TGIF

2007-11-30T06:42:00.000-08:00

Images from top down - the church, houses occupied by doctors/hospital staff, a typical mango tree. More houses.

Warning - this blog has a lot of medical jargon - sorry in advance to non-medical people, just came off of a long call night and work day today!

Hope you had a good week back home. I am definitely glad its Friday! The past 24 hours have been a blur because of a very busy call night last night, and work day today! And to top it off, my work day ended arguing over a chicken..... I admitted two patients last night s/p trauma. Having to rely on my med school trauma and ortho experiences is difficult and to make it more interesting I usually understand about every third word when I take a history in Kiswahili!

The first trauma case was s/p MVA came with a compound fracture of the humurus and femur. He was transferred from a nearby hospital......Later in the evening a 5 day old girl came with abdominal distention, constipation and nausea/vomiting, most likely an obstruction. An NGT put out 150 cc of fecal material; she received an enema this morning. The highlight of my call came around 4:15 this morning. Our teenager who induced an abortion with local herbs, and then had a D&C had been spiking fevers, without responding to antibiotics. She developed an acute abdomen and we took her to the OR at around 5 for laparotomy/lavage for peritonitis and she had a ruptured abscess with purulent fluid filling her abdomen.

There were no gyn cases on the schedule today, so I assisted on a laparotomy for a enterocutaneous-fistula repair that developed after a hysterectomy. Interesting case!

The work day was almost over until I glanced at the last patients chart. She was lying on a stretcher outside the theatre. The history said abdominal pain, and vomiting. There were no vital signs, and a one line exam, then impression - ectopic pregnancy. We took the patient for an urgent ultrasound that showed free fluid and an adnexal mass, consistent with ectopic. She was pale and tachycardic so we called for emergency laparotomy. Emergency ended up taking about one hour because soon after diagnosis, we had a downpour of rain. The nursing staff and anesthestists must have taken that as a sign for a break and did not transport the patient back from the ward. Nevertheless, about an hour later, we suctioned out about a liter of blood from her abdomen and removed the left tube and ectopic pregnancy.

Regarding the chicken - Yesterday I was walking down the street to the post office with one of the local boys who works in the kitchen and has the one and only key to the post office. Making small talk, I asked him if he knew where I could buy some chicken. He said he has some and told me to stop by the store tomorrow (today). Just before going back to the OR with the ectopic one of the nurses stopped me and told me a man was waiting to sell me his chicken. I was in the midst of trying to get the patient back to the OR and mistakenly told him to wait until after the operation. I walked out of the OR heading home when I saw the boy and an older man with a live chicken. He stopped me and insisted that I buy his chicken. I tried to explain, I did not want to buy a live chicken because I don't want to kill it, and more importantly have a live chicken running around in the house! He was very dissapointed, but I think I learned my lesson - careful what you wish for in Kiswahili. I walked back home with the tune of Curb your Enthusiasm ringing in my head.

Hospital

2007-11-27T09:10:00.001-08:00

(From top down) 1. The procedure room in labor and delivery - where all of the D&C's take place.

2. Beds in labor and delivery - deliveries performed here.

3. More beds in L&D

4. ? A fetoscope - Nurses use this to record/monitor fetal heart tones! **

5. Ultrasound machine in labor and delivery - a newer, nicer machine is located in the theatre.

6. Main outdoor corridor through the hospital - usually filled with patients and families

7. Benches outside of the theatre. By mid afternoon filled with patients referred with surgical issues.

8. Conference room - morning conference takes place here

9. Physiotherapy department

10. Pharmacy sign

** One of the biggest "challenges"/frustrations of working in the maternity department here is this instrument. Fetal heart tones are monitored once per hour in laboring patients and once daily in antepartum patients! Standard of care in western countries is "continuous monitoring" of all laboring patients and much more frequently in antepartum patients.

I was on call Monday night. Soon after my shift started our triplets ruptured membranes. I delivered the triplets (33+ weeks) by c-section and the three babies did well. All delivered breech (2.6kg, 2.0kg, and 1.6 kg). Mother and babies doing well. I asked the mother if I could take a picture of her and the babies but she declined. Sorry no evidence!

I am looking forward to my "annual volunteer conference (AVC)" coming up next month. All of the volunteers in Tanzania (about 65) are meeting in Dar Es Salaam for meetings and to share experiences. I'll be in Dar Es Salaam from December 17-20th for the conference.

I'm spending one day in Dar to look around at medical suppliers, hoping to buy some dopplers for the maternity department!!

After AVC, I requested a little holiday because most of the volunteers have time off during christmas. So I'm going to go to Zanzibar over this holiday period. I'll be in Zanzibar December 21-26th.

Shangani Beach

2007-11-25T07:51:00.000-08:00

This weekend I went to Mtwara, the largest city on the south-eastern coast of Tanzania. With three of the other "volunteers" we drove about two hours east to reach Mtwara. In Mtwara we stay at one of the villas owned by the Benedictine Fathers, located on Shangani Beach. The beach house has 5 bedrooms - (perfect for our group of volunteers to share) and these spectacular views of Shangani Beach and the Indian Ocean. The gate leading to the beach is about 10 yards from the back door.

The hospital administrator Mr. Piet, myself, Sheena (lab tech), Francijn (Dutch doctor) and Diane (community HIV coordinator) shared the house Friday night along with the former ambassador to China who is temporarily living in the beach house.

If you read the Bradt Guide to Tanzania, the South Coast of Tanzania is described a "fascinating, thought-provoking and often enchanting area, endlessly rewarding to those with a sense of adventure and curiosity."
This is definitely true. The highlight of the weekend was by far the snorkeling. Shangani Beach has a magnificent, beautiful coral reef that is perfect for snorkeling. During low tide you can snorkel for a couple of hours.... The reef has an amazing variety of fish, and aquatic life. I couldn't name a quarter of the fish we saw but the bright fluorescent colors are awesome. Among the fish were a lot of jellyfish! Scary at first but they are really harmless. The sea urchins are amazing with sharp shiny blacks spikes and bright orange eye. In one picture we are heading back from snorkeling (Mr. Piet, Francijn, Sheena and I).

The coast line is amazing ~ 360 miles of pure white sand along the Indian ocean - also amazing is that there are virtually no tourists! There are a few Tanzanian boys running along the beach and a few fisherman. There is a rare sailboat visible along the horizon.

After snorkeling we drove into the city of Mtwara (population ~100,000) to do some shopping. A very productive shopping spree- I bought a bike and a lot of food, pasta, cereals, noodles, tuna fish, etc, lot of canned foods, and some wine to last a while.

In the afternoon, its high tide so we went swimming - the Indian Ocean is not only amazingly blue this time of year but the water is "soupy", the warmest natural body of water I've been in, felt like a heated pool!

We ate dinner at the Southern Cross Hotel - described as the best restaurant in Mtwara - and the food was certainly good - but what is the best is ambience - we sat outside on a large outdoor patio overlooking the Indian Ocean. At night when there are no clouds the sky is filled with stars. Last night, a full "golden" moon arose from the horizon and lit up the sky. Quite amazing site. We enjoyed Indian food with a nice Chardonay overlooking the Indian Ocean.....

For after dinner entertainment we drove to one of the other volunteers' (Mikaa) home for a little party. Mikaa is another dutch doctor/HIV coordinator who has been living in Mtwara for almost two years. She had a party for one of the volunteer's birthday, so we stopped by her house to catch the end of their dinner and then we stayed to watch a movie.

Today was more R&R. Snorkeling this morning during low tide and then relaxing by the beach with a book this afternoon. We drove back to Ndanda late this afternoon. I unloaded my new bike, all the food, + wine, + liquor into the house and then went to the Abbey kitchen down the road to buy my milk, jam, and bread for breakfast tomorrow.

I'm on call tomorrow so I'm going to sleep early tonight, to be rested and prepared for the unexpected tomorrow.....
http://www.flickr.com/photos/21232655@N07/ If this link works I'll try to put up more pics!

City Slickers

2007-11-21T05:32:00.000-08:00

Last night I was on call again, and it was almost the best call night I've ever had......until about 3am.

At 3 am labor and delivery called to say that twins were in labor. Excellent I thought! But the presenting twin was breech. When twins are in labor and the presenting twin is breech, that means one thing - warm up the OR and get ready for a c-section.

By the time all the necessary people arrived (nurses, scrub techs, anesthestist, ect) it was around 4). The c-section went well and both babies had apgars of 9 and 10. I was back home by about a quarter past 5 and then slept for another hour, with many fond memories of residency calls doing c-sections at odd hours of the night.

I was walking home from the market the other day and passed this herd of cows and goats as they were passing by my house. I happened to have my camera with me, so a good time for a photo op. The herd reminded me of one of the scenes from the movie "City Slickers".....

Well, I hope everyone is well back home. In case you don't have my new email, neil@ndanda.net or we can talk with Skype (Skype is free to download and lets you talk online anytime). Please keep me in the loop of all of the news/events/rumors/gossip that is going on!

Good news, bad news, and.....peanuts?

2007-11-19T07:48:00.000-08:00

This is a photo of the butcher's shop. Its just down the road from my house but I've only been once because he closes at noon and I'm always working then.

I've chosen to post this picture because I simply don't have anything more exciting at the moment.

OK, So do you want the good news or bad news first? Well I'll start with the good news.....

I found out today that I will make $3,600 schillings everytime I'm on call at the hospital!!

Bad news - that equates to about $3 US dollars! Almost enough to buy a loaf of bread.

Speaking of bread, I went to the kitchen to buy some bread, eggs, milk, sausage and jam today for $7,900 Schillings. I gave the sister $8,000 and said thank you, and was about to leave but she insisted on giving me 100 Schillings - a little less than a dime! When it comes to money and budgeting I think I still haven't adjusted my thinking.

Ok here is some news that is not bad, its worse! I agreed to take call almost every third night the rest of this month! Partly because one of the AMOS (Assistant medical officers) is not going to be here for the rest of the month. I think he is spacing his calls because he is leaving.

I'm going to play it by ear and see how the calls go.....

Today's surgery schedule included a hernia repair, tibia fixation, atheroma removal, repeat c-section and total abdominal hysterectomy. I was hoping to do both the c-section and TAH. I did the repeat c-section and then I went to the other operating room and the gen. surgeon (Sr. Regina) was almost finished with the TAH.

I'm on call again tomorrow. When you take call you have to work until one pm. The call starts at 4 pm until 8 am the next morning. Then you have to work until 3 pm the next day. I'm starting to wonder if the 80 hour work week during residency was better!

Actually the call is not that bad, and my house is next to the hospital so if its quiet I can go home and try to sleep.

New to my cooking repertoire - red beans and rice! I went out on a limb and decided to try to make red beans and rice. The rice tasted like rice but the beans a little more like peanuts. Any suggestions on how to cook beans?? Your humble chef, Neil

Surgical call

2007-11-18T02:55:00.000-08:00

Another picture of Chemchemi - I'm heading there in a little bit to go swimming - its hot today, feels like around 90 degrees. There is usually a slight breeze during the day and it cools off during the night.

Ndanda is about two hour west of the coast and at a higher altitude than Mtwara, (the larger city on the coast) - so the climate here is a little more temperate with a little less humidity.

I took Surgical call last night. I'd say it was a successful call night. For one I managed to stay out of the operating room and two I did get a little bit of sleep:)

The first patient I admitted to the male surgical ward; he fell off a motorcycle and landed on his head/back....he actually had been admitted to a close regional hospital and referred to Ndanda because his condition was "deteriorating". According to his transfer papers, he had a fractured tibia. He also had a lot of bruising around the eyes, and had old stitches. He was actually conscious and clinically stable, with normal vital signs and benign exam. I'm not sure why he was "deteriorating", but I admitted him for pain meds and to get xrays today. He will probably go to the theatre tomorrow with the orthopod.

Things had quieted down until about nine and then four patients arrived almost the same time.

Two patients were referred together from a different nearby hospital. One, an old woman who had sprained her knee and a yound girl who came with pain and swelling of the vulva. I believe she had a Bartholin gland abscess. I tried to I&D the lesion but didn't get much fluid back. Plan to do an exam under anesthesia, and either word catheter placement or marsupialization tomorrow. A couple women came in labor and delivered normal vaginal deliveries. A young girl came after she delivered a nonviable fetus at home, with the placenta in-situ. I gave oxytocin, but did not have much hope that the placenta would deliver spontaneously. So around 1am I got a call that she had started bleeding. I went back to do an evacuation - was more difficult because the placenta had to be extracted in pieces... she was feeling fine this morning and bleeding had stopped so I hope all of the membranes are gone.

My relief was supposed to come at 8 but I didn't see him, so I hung around until half past then was told he might be in church. A woman arrived with three prior c-sections, full term, rule out labor. Fortunately she was not in labor and could wait until the next shift.

About to go to the pond for a swim because its beautiful today.....I certainly can't complain about the weather!

BTW many of the volunteers here have been having visitors come, so I expect you to start getting your vaccines now and make sure your passport is current. I have a spare bedroom waiting for you. I can provide you with the food and accomodations - but not making enough money to pay for the airfare, sorry:)

Kanga

2007-11-16T09:01:00.000-08:00

Here I am at Chemchemi (sp?) the pond where I go to swim in the afternoons. I just arrived after a 45 minute walk along a dirt road. I usually listen to my ipod along the way, sometimes to music other times to medical lectures that I have downloaded.... I have about three weeks of obgyn lectures downloaded on the ipod so the long walk is a perfect time to study :)

Its difficult to see in the picture, but the priests are swimming in the pond behind me. Its just after 4 pm and a perfect time to swim. It was a beautiful day today, probably in the low 80s, and then cooled off to maybe mid 70s by the time I walked home.

Today I started in maternity rounding on labor and delivery/antepartum/postpartum and then went to the theatre as usual. There was a vaginal hysterectomy on the surg. schedule today which I was looking forward to doing. After I finished in maternity I went to the theatre hoping to find the patient, but I saw the general surgeon already in the middle of the case, actually almost done. I was a little disappointed, because vaginal hysterectomies are not that common and I was looking forward to doing it, but the surgeon told me she had to cancel the first case because of a fever, and not to worry I would have plenty of opportunities in the future...... After the case, maternity was quiet so I just assisted the surgeon on the remaining cases today - a herniorraphy, followed by the removal of an obvious cancerous tumor from the buttocks of an elderly lady. Finally a toe amputation in a young girl after a snake bit her and caused gangrene and osteomyelitis. The girl was amazing in the sense that she was so calm and appreciative of everything the hospital staff was doing for her, in the moments before she was about to loose her big toe!

As a generalization, patients here are alot more appreciative of the care they receive compared to those in the States, which is definitely nice. Side tracking a bit - its interesting that although patients get preop counseling on all the risks/benefits/indications to surgery there is no consent form that is signed. I guess I should not be that surprised given that I am working in Africa, but still the documentation of informed consent is a big deal.

Its a three for one special today, with three pictures. I was hoping to put the pic without the shirt on beneath the other one, as a before and after, but I can't figure this blogger posting picture thing out.

The top picture is of a Kanga; A Kanga is a lizard that looks exactly like a crocodile or alligator only about 10 or 20 times smaller.

There is a baby kanga that lives in Chemchemi. I almost tripped over him when I arrived because I did not see him in the sun while he was sunbathing. After a little while he jumped in the water and I swam with him to the other side of the pond.

This evening I did not make it to the kitchen in time to tell the sister that I wanted to eat in the Abbey because I did not have any food in the house, so I went to the one and only restaurant in Ndanda, Subiaku. Some nights they play music, tonight they had live music because there was some sort of hospital party.

I'm taking surgical call tomorrow. So I'm going to go to sleep early tonight. I'm not sure what to expect on surgical call - it could be an adventure! I'll keep you posted! Again, thanks for writing comments; Hope all is well in North America!

The priests and the quadruplets

2007-11-13T10:46:00.000-08:00

The black shirt is used to hide any evidence of weight loss/gain on my new diet of carbohydrates and more carbohydrates:) This is my "pre-blog" pose and if you look closely you might see a smile :)

Yesterday afternoon I went for a swim in "Chemchemi" (sp?) the man-made natural pond in Ndanda, aka our swimming pool. From my house its about a 45 minute walk along a dirt path through some bush.
The pond is roughly the size of a football field, maybe a little larger and is surprising always very clean and Very refreshing during these hot humid afternoons. Almost every afternoon at four o'clock a group of four or five priests from the Abbey go for a swim; and unless the other couple of volunteers come with me, I'm swimming alone with the priests......

Last night I visited with two of the other "vols" who have been here now about a year. They have acccumulated quite a DVD collection......there is not a lot to do here at night. So after so many days of reading and studying Kiswahili, I took a break and watched A Beautiful Mind (again). The girl living next door to me is a Dutch doctor from the Netherlands. She arrived about a year ago and is focusing on improving the HIV program at the hospital. Next to her is another girl who is a "vol" from Colorado, also here since about Oct. last year. She is a lab tech, here to strengthen the lab. The two of them must have a love for cats, because they share four cats that stay in the houses. One of the cats gave birth to quadruplets the other day. One of the kittens died yesterday but the others look healthy. We are not expecting any more kittens because the girls performed a vasectomy or something similar on all of the males. (Not sure who the father of the kittens is:)

I think I'm starting to get into a routine. In the mornings after conference, I round on maternity patients. There are usually about forty to fifty patients to see. Usually three or four patients in labor and delivery and twenty-somethinng patients on both post partum and antepartum. I round with one of the assistant medical officers who has been covering maternity. And between the two of us, we split the patients.
Rounding takes us until about ten o'clock and then its time for the mandatory "tea break" which I believe all Tanzanian's believe is a necessary part of their day. I usually skip tea and go to the theatre.

In the theatre today, we had a laparotomy, oophorectomy for a large ovarian mass in a sixteen year old girl. She had a fifteen or sixteen centimeter mass that occupied almost her entire pelvis. Fortunately it was obviously benign in appearance, so it was easily drained and removed.

After operating we see the outpatient surgical patients. Outside the theatre are benches filled with patients. Usually there are thirty or forty patients waiting to be seen, referred from an outpatient clinic, or sent from the ward. There are four or five exam rooms, one gyn room and ultrasound. We document all of the findings/exam on a little card, that the patient keeps with them. Seems to be a very efficient system.

The short rainy season has started. We had a sprinkle yesterday afternoon while I was walking back from the pond, and a downpour this afternoon for about an hour. The short rainy season is supposed to last from about November through January. It is definitely nice to get a little bit of rain to cool things off in the evenings.

Hope everyone is doing well. And let me know when you plan on visiting!!

Theatre

2007-11-09T08:04:00.001-08:00

Finally I started work in the OR (aka the "theatre).

For me it was a perfect day to start in the theatre because we had one scheduled total abdominal hysterectomy, and one emergency c-section for fetal distress... in between there was a minor orthopedic case that I scrubbed to assist the general surgeon....

The first patient was severely anemic due to fibroids with a hemoglobin around 6. (There is blood available in the hospital but its used very sparingly). Fortunately, the case was uncomplicated and we finished within an hour. The patient did not loose that much blood but she received a unit of blood immediately after the case. (BTW there is no offical Estimated Blood Loss documented), infact a lot of information is just not being recorded by the anesthestists or even some of the doctors....

Supplies are limited, eg - preop antibiotics are not given (because the hospital is in short supply) and lower extremity sequential compression devices are not available. Surprisingly, I'm told that there are not that many post op infections or DVTs......

Second on the OR schedule was an orthopedic case - removal of a plate after an ORIF. A short, straight forward case for the general surgeon, who I was definitely pleased to see has very strong surgical skills.....(BTW I just assisted on the ortho case today to get more time in the theatre....)

Soon after the ortho case, a woman was brought from L&D for an "emergency c-section."

For an "emergency c-section" the nurses and anesthetists worked very slow, but we were quick to deliver the baby who had apgars of "10 and 10" :)

The working day ends at around three or three-thirty which is definitely nice! However, I'm going to be working six days a week. And, seems as though I will be taking some "surgical calls"....

The picture is of the market that I go to to buy my fruits and vegetables. Everything is very fresh, and now its mango season, so it is the best time to buy fresh mangos in Ndanda.

My next post will have to have a picture of me, or at least the hospital as requested by Justin. (BTW, Justin and everyone else thank you for reading and writing comments) Justin, I didn't get a chance to talk to you before I left, I hope you and Jaime are doing well. Stay in touch.

Jumatano

2007-11-07T03:02:00.000-08:00

A view of the front of my house. There are 3 "houses" in this building. I live on the far left side if you are facing the house.

The path from my door leads to the hospital which is about a two minute walk to the morning conference room - a little better commute than I had in Chicago:)

Today I rounded in Wodi 2 - the male surgical ward. There were 54 patients today - mostly orthopedic cases, but some general surgery and urologic cases. I rounded with one of the Tanzanian Assistant medical officers and the orthopedic surgeon. Most of the orthopedic patients were s/p fractures that had been internally fixated? (Sanders - i'm sorry if you read this and I'm wrong with the ortho terminology, its been over four years since my ortho rotation). Many patients were post op after having an ORIF - open reduction, internal fixation. There were a couple of post op prostatectomy cases, hernia repairs and hydrocele repairs. Two boys had been admitted after snake bites to the feet. Both had a large amount of soft tissue damage in the foot. One man was admitted after an aligator attacked him and injured his arm/shoulder.

This afternoon I was walking back to the hospital to go to the surgical outpatient department, when I walked past one of the german nuns, who stopped me and introduced herself. She has worked as a doctor/teacher at Ndanda for the past 35 years. She was on her way to the nursing school to give a lecture and invited me to listen, so I came with her. This nun is also a doctor and at one time practiced gynecology, now she works in the family planning department.

Her lecture today was given to the 4th year nursing students on a very interesting topic - "cervical mucus":) She introduced me to the nursing students, who looked like they were pleased to have a visitor in their classroom.

The nursing school class had about 30 or 40 students that are probably in their late teens, mostly girls. Most were busy taking notes, some looked interested, others asleep during her lecture. I was curious how much of the lecture the students understood as every word was spoken in English.

After the class I met one of the other clinical officers who works maternity and also surgical outpatient department. He is older and told me he's going to retire in a couple of years. He was absent from morning report this morning because he was doing a repeat cesarian section late last night. His afternoon clinic was very slow, so a good time to chat and get to know him. He told me that the administration is setting up my office next to his. I was surprised to hear this, as I was not expecting an office of my own.

The afternoon clinics usually run until about 3:30 and then most people are done with their work, unless they are working a night shift or on call.

Its hotter than usual today so I went back to the house. I keep the fan on while I'm in doors because even with the lights off and shades closed, the house gets pretty hot. Today Janet, my housekeeper came to clean. She charges 5000 shillings (a little less than 5 dollars). Obviously way less than any American, but probably more than most house cleaners make here, and on my salary it probably evens out.

Dinners for me are still a dilemna/challenge. Until I learn to cook I expect to loose a few lbs's. Last night I walked to the (only?) restaurant in Ndanda, which is just down the road. They sell chicken, meat, fish, rice, etc.....I was craving chicken but they were out of chicken so I ate the fish - edible, but not good by american standards; however, much better than my spaghetti and tomatoes!

(BTW Jumatano is Kiswahili for Wednesday. The thought of "cervical mucous" as a title for this post crossed my mind but then again Wednesday is a safe enough choice:)

Wodi 4

2007-11-05T10:14:00.000-08:00

Today I spent the morning in Wodi 4 (ward 4). As a part of my two week orientation, I rotate through each of the wards in the hospital to become better acquainted with the staff and patients.
Wodi 4 is the pediatric ward and was managed by Victor today. Victor is one of the local "clinical officers" working in the hospital. St. Benedict's has a number of Assistant medical officers = 4 years of training, Clinical officers = 3 years of training and medical officers (4 years of school + training). So I believe that I am one of 6 medical officers. There is one visiting orthopedic surgeon, one general surgeon, two medical doctors, and one HIV/tropical medicine doctor (also a VSO volunteer) and myself. (The maternity ward is run primarily by two assistant medical officers who I have not met yet).
Victor and I rounded on about twenty -two peds patients this morning. Like most of the wards in the hospital, Wodi 4 has roughly about 30 beds, arranged almost side by side in one open room, which is "relatively clean" but does have a lot of flies swarming around.
Most, if not almost all of the children are admitted with malaria, which is by far the most common illness children get admitted for. Most children present with fevers, malaise, body aches, and GI or respiratory symptoms.
As an aside, what becomes obvious very quickly when working in this hospital or in countries of "tropical medicine" is that so much of the day to day care/treatment of patients relies on the clinical judgement of the doctor, i.e. the routine labs and imaging are not being performed. Sometimes its hard to imagine what limited resources this hospital is faced with, but it is a reality!
At around 11:30 after we finished rounding, one of the nurses came in to tell us that there has been a change in the status of one of the patients. A young girl who had severe malaria and hydrocephalus was brought into the "intensive room". Her eyes were closed and she did not move. It was obvious that she had passed. Victor confirmed that she died and we told the father, who was appropriately sad.
According to the St. Benedict's Ndanda Annual report, last year 87 children died. I will never know how my impressions/feelings about death compare to those of the people of Tanzania who are faced with this reality each day. When there is a death of a patient, the nurses end their notations in the log book the same way each time, let us pray for him, amen.
On a little lighter note, I had the afternoon free so I went for a walk around the town. Its definitely getting hotter here (i'm sure you feel sorry for me:) and I wished I had some sunscreen on; I feel a little bit awkward walking around because people I meet or have not yet met, seem to already know me. I went to buy some milk and eggs from the kitchen and when I asked the sister if I could have milk without cream, she said "why don't you like cream? you are a doctor, you should know its ok". I was surprised to hear this from someone I had met only once before!
On a different note, I expect to have some new pictures up next time. I've been spending a lot of the down-time studying Kiswahili because its becoming very apparent that to gain the respect of my colleagues and patients means speaking without an interpreter. I will try to take a break from studying/working and re-enter tourist mode with my camera tomorrow!

Nyangao

2007-11-03T08:15:00.000-07:00

I'm spending the first week in "orientation" to become more familiar with St. Benedict's Hospital. Each day during orientation I have to round with the doctor or medical assistant in two different wards.
This morning I started in the medical outpatient department.
I introduced myself to Lillian, the medical assistant covering the MOPD (medical outpatient department) and sat in her office while she saw a few of the patients. By the third or fourth patient, she handed me the chart and wanted to me to start seeing the patients. There was some misunderstanding because in my Swahili I tried to explain that I would just be observing her. But she insisted that I see the patients and I didn't mind so I prepared. Luckily all of the charting is in English but of course none of the patients speak English. I tried hard to take a history in Kiswahili, and for the most part, patients understand me, but I still have difficulties understanding the spoken language. I had two interpreters with me......A few of the first patients had multiple problems, diabetes, hypertension and just came for medication refills. The next patient was a four year old boy who was carried into the room by his mother. His eyes were closed, he looked very weak and sick. His mother gave the history - fevers, abdominal pain, sore throat, nausea and vomiting for two days. The nurses took vital signs and I did a physical exam.....I spoke briefly to the medical assistant to discuss my differential diagnosis and possible work up, but she didn't hesitate to say that he has Malaria. I asked if we would get blood tests or do any other type of work up. She said no.... so I admitted him to the peds ward with medication to treat presumptive Malaria.
By ten am, I had to leave to accompany other hospital employees to drive to Nyangao, a sister hospital in the village of Nyangao about an hour east of Ndanda. Nyangao Hospital was host to today's monthly medical conference so about 50 health care workers from 4 regional hospitals met to hear lectures by 3 doctors. Coincidently the lectures today were OB related. A general surgeon gave a talk on wound healing, a gynecologist at Lindi hospital talked on management of normal and abnormal labor, as well as complications in C-sections, finally one of the medical assistants gave a lecture on post op c-section wound infections at Nyangao hospital. Very interesting to hear the perspective and management. There are many differences b/w practices in US hospitals compared to Africa (obviously). Some very basic medications are not available, and as a result there are higher numbers of c-sections and complications. Even pitocin, one of the most commonly used medications on a L&D ward to augment labor is sometimes not used, because it is not available!
By the time I returned to Ndanda it was late afternoon. The hospital administrator and other volunteers living next to me had already left for Mtwara for the weekend. I spent the afternoon walking around the town. The butcher was closed so I went to the monastery kitchen and bought some milk, eggs, bread and some sausage - enough for dinner tonight! Hint - please send recipes and/or the Idiots Guide to Cooking! I don't know how long I will last on scrambled eggs and sausage!