Gathering with the Ilula Nursing Students

As we entered the dining room the students were singing a familiar song for Dan and I and probably for anybody else who visits the Iringa area for the partnerships: "Unity." For us it was very representative of our group and it was for the 1st and 2nd year classes of the nursing school as well. The students come from various regions of Tanzania including Dar es Salaam, the Iringa area, Tanga, Mwanza, Morogoro, Arusha and others. They danced ethnic dances from these areas if there was a group of students from the respective regions. They introduced themselves and asked us to do the same. They would be excellent role models for our country right now. I find that people in the US have less inhibitions on their behavior and what they say to others speaking in different languages or of different color and witnessed this when we had visitors from Tanzania soon after our election. We also witnessed this on our very first trip to Tanzania: one of our group asked, "how do you cope with the call to prayer at 5 in the morning?" to which our guide shrugged his shoulders and said, "They put up with us (Christians) and what we do, why shouldn't we tolerate them." This group of nurses clearly stated to us that they are in this together to get each other through the nursing school. I feel exceptionally blessed on this trip: our group consists of 2 pharmacy students from the U of M's program, one of whom is Nigerian, two family medicine residents, one of whom is of East Indian decent and of Islamic faith, one retired family physician, an ER physician of East Indian decent, a chemist/software engineer, a brick mason married to a pharmacist, both of whom are Jewish, and myself, a nurse practitioner. We are having such a wonderful trip with all of these people; I wish I could spend another month with this group, just to learn more about each other and spend more time with them. Everybody has been very inclusive with one another and has had something unique to offer to one another. After the dance performance by the students, we gathered outside and the students were literally going nuts with their cell phones taking pictures with us. Once again, we experienced an all inclusive gathering. They wanted pictures with the lovely young women in our group as well as us old people. The love of these people is so palpable.

First year students African dance

Photos with rafiki (friends)

Friday in Ilula

1/27/2017  (Pole sana!  Late entry due to internet problems)

The week came to a close with a mix of emotions… spent the last few days in the inpatient wards.  Yesterday saw a patient admitted with worsening respiratory distress, clinically with a pleural effusion on exam and on treatment for suspected pulmonary TB vs pneumonia.  The patient had been recommended to be transferred to Iringa, the regional hospital where a Chest Xray could be obtained, oxygen would be available and doctors there could … but unfortunately the family could not afford it.  Luckily an ultrasound machine is available and I was able to teach one of the doctors here how to confirm a pleural effusion using the ultrasound machine.  A bedside thoracentesis was successful removing almost 1.5 L of fluid... seeing the smile on his face was priceless.  Eventually, I had to force him to rest and stop hugging me in thanks.  Not only was it heartwarming to be able to help that patient specifically with a procedure he wouldn’t have received otherwise, hopefully Dr Sovelo will be able to use the increased ultrasound knowledge and education on thoracentesis going forward for many more.

Although that case had a positive turn and hopefully he continues to improve… the day was a hard one, having a young patient pass away from complications of burns from a cooking fire.  They had been improving but suddenly worsened overnight and could not be revived.  Their empty hospital bed in the corner a reminder of one of so many examples of simple things that are so easily taken for granted… a safe place for parents to cook food.

The days are flying by and can’t believe we’ve been here two weeks already.  Excited to see what we learn from each other and hopefully can provide to our hosting friends to better this wonderful community.

Back in the USA

After landing and making it through customs at MSP-St. Paul International Airport yesterday, I pulled out my smartphone to call a cab and was instantly pulled back into our first-world, technology-dependent society. I was disappointed. I had already been in contact with Prosperity to hear about the events from the day back in Ilula. I was also in touch with Mahveen and Nadia in Tanzania and Margaret in Uganda. I wanted to go back. As I unloaded my luggage into my warm apartment and took a hot shower, it dawned on me how extremely fortunate I am. I already knew that, of course, but it was another reminder. Still, I want to go back.

There were days on this trip when I struggled - mentally, physically, and emotionally - but I wouldn't change those days for anything in the world. I'll never forget when I walked into the room where a patient was already deceased...or the day when I saw a live birth and C-section over the course of six hours. My knowledge of infectious disease grew exponentially during my time in Ilula - a lot of this was due to my experiences with the patients but also thanks to Randy who took every opportunity to teach me and encouraged me on rounds to become more involved and write notes (even though he could probably tell that I was a wee bit apprehensive at first). :) The group pushed me to review topics (and medications) I did not know and our daily teaching sessions were extremely informative (especially the medication-related sessions - have I mentioned that yet?). :) I know that I'll never know everything, but seeing the passion radiate from the members of our group was more inspiring than I could ever explain and I only hope to be able to bring that back to my practice.

A huge thanks to everyone in our group! To those who are already gone, you were an absolute joy to be around. To all of you still there, keep up the good work and take care of yourselves and our Tanzanian friends. :)

The Ambulance

I got to take a closer look at the ambulance today.  No worries, just an inspection, not a personal usage. It had been out of the compound for a couple days taking a patient to Dar.  Godwin, the driver, showed me a few things.

First, it has a gurney that locks in place, like any ambulance should.  I noticed it was very secure.  There is an oxygen tank.  It has a hook for an IV bag. 

There are two seats, each bench seating two, and also the passenger seat.

He showed me the cabin too, with its siren and light switches.  Note the round red and white buttons above the air conditioning controls in the photo.

He even turned on the light for me!







 Godwin then showed me the powerful engine under the hood.

“Very powerful,” he said.  The engine runs smoothly at highway speeds.  It is obviously a pleasure to drive.



"And new," meaning reliable!

Ilula Orphan Program

so i am not apart of the medical group but am volunteering with IOP ( ilula orphanage program) on starting to build the new office building and help with road repair which oddly are very related. the Tanzanian people do not have very much but have learned to use what they have and with a country full of natural resources is not very hard to come by but take a lot of work to get. so while starting the foundation work for the new office building we must clear the land of all vegetation and rocks in the soil. Instead of making  a pile of stones they use the stones to fill in areas of the road that the rains have washed away or even used as the aggregate used in concrete. I have also had the pleasure of working with 5 locals in the same age group as me (27) so i have been able to immerse my self in the culture from a real world perspective. The Tanzanians i work with have also taken it upon themselves to  teach me swahili and the reason they take this goal on is not to just help me but as my coworker sadiq told me, "he wants for me to be involved when we talk so i can be involved and have fun". i added a photo of where my job site which is very beautiful. usiku mwema (good night) to all of the group since i am writing this so late or to anyone reading this now habari za mchana (good afternoon).

Last Day of Safari

1/24/2016

Today is Day 2 of our Safari at the Ruaha national park. i was woken up by the very polite staff member of the Mwagusi Lodge who stood outside our tent with coffee and tea and softly kept repeating "Helloooo, Hellooooo!"  It was definitely not hard to wake up when you are waking up to the beautiful Banda of the lodge and a guaranteed hot shower. Plan for the day was to have one last game drive on our way out of Ruaha national park and head back to Ilula.

We started off with a delicious breakfast and then quickly headed out on our game drive, our guides Vincent and Godfrey asked us what we wanted to see today and we all agreed that male lions was a must before we left. Sure enough we saw a male lion with his pride! One male lion with about 5 females, all feasting on an elephant carcass. Saw lots of giraffes, elephants, and even hippos as our last sighting before actually exiting the park. After a delicious lunch we get back up with Abu our driver and started the long bus ride back to Ilula.

After a long day of game driving in the sun we were all looking forward to falling asleep on the bus although to everyone's disappointment the ride was very bumpy and even if we did fall asleep we were quickly jolted out of sleep every time the bus passed over a rock. The trip was supposed to be about 3 hours to Iringa and then about 2.5 hours back to Ilula. Just about 30 minutes from Iringa our bus came to halt as it was trying to go up a very steep hill. There was a lot of waiting on the side of the road, trying to push the bus, and praying. Finally 2 hours later, poor Abu with the help of a couple of locals got the bus up an running and we made it safely to Ilula by 9 PM hungry and tired from the long journey.

After a delicious dinner prepared by Ana we fell asleep with plans of waking up nice and early for a morning run, and getting back to reality of wards after an unreal couple of days at Ruaha. 

P.S. Due to internet problems submitting this late entry!!

Kising'a Village Funeral

Sue is a nurse here in the group and I am tagging along to do some computer work at the nursing school and visit some secondary schools.  Our church at home has a partnership with Kising'a village in the mountains above Iringa and we decided to visit them while the rest of the group was in Ruaha (don't feel sorry for us, we have been to Ruaha many times).  We have a personal blog that we use when we are in Tanzania and below is an entry about a funeral we attended in the village this weekend.

Our blog url is http://danandsueintz.blogspot.com/
Here is an entry from our visit to the Ilula Nursing School which might be of interest to this group.
Ilula Nursing School

Dan and Sue McIntyre

When we arrived on Saturday, we were very sad to hear about an accident in Kidumuka that killed a mother and her 14 year old son.  A lightning strike on the solar panel on their house sent electricity down a wire into a room where it exploded onto the two taking lunch.  Both were burned badly and killed instantly.  Small solar panels are becoming very common here and advances in LED lighting has made them very effective.  Unfortunately, technology is not always applied in the safest way possible and many solar units are not grounded.

The funeral was the next day after Sunday service and we were invited to participate with the group of evangelists.  We took the car to Kidumuka because it was still wet and looked like it could rain again.  The bodies were still in the small mud brick home with many relatives sitting with them grieving.  A couple pine board caskets were brought to the home and several hundred people gathered outside.  The bodies were brought out wrapped in blankets in the caskets and the service started just outside the home.  All of the evangelists participated in the funeral liturgy.  The blankets were uncovered to show the faces of the mother and child, with care to keep the burns covered.  A blanket was brought out to be held above the caskets as all the people slowly walked by the head of the caskets.  We were close with the evangelists and I was able to hold the edge of the blanket high.  After all had been able to walk by and acknowledge their deaths, the faces were carefully rewrapped and lids were placed on the caskets.

Kidumuka  village lies along a ridge across from the main preaching point of Kising'a and the burial site was well down the ridge almost to the valley.  The crowd went down the trail to the site where graves had already been dug. As we walked, someone collected donations from the attendees to pay costs for the funeral and reception afterwards. Two holes, about 5 feet by 7 feet and 4 feet deep had been dug in the clay with a casket sized hole at the bottom for another couple feet.  The crowd gathered around with most being far back on the hillside.  We were with the Evangelists at the graves, the choir was singing whenever the pastors were not speaking. The caskets came and about four men in each hole made measurements with a stick and dug out the casket sized hole to fit.  The caskets were lowered in the graves and Pastor Shukuru preached a message very loudly so the distant people could hear.

Bags of clothes were placed in both graves to be buried with their owners.  Dirt was added to level the casket depression and then a cover of lumber trim boards was placed on top, followed by a blanket.  Each of us in the evangelist group then tossed a handful of dirt into each grave three times. The family then did the same before a group of men filled the rest of the holes.  The dirt was a piled high and carefully patted smooth by grieving family members.  At this time, several people spoke about the departed and the man who had collected contributions read all the names with contribution amounts.

The crowd walked up the hill at the end of the service in a long line on the steep trail.  Large buckets of ugali (maize staple with the consistency of mashed potatoes) and beans had been prepared for the guests.  The entire service lasted more than 3 hours and we were standing the entire time in the open. The lives of the husband and another child will be severely impacted both by grief and by loss of the mama's role in the household.   Other family members will help to fill the void.

The funeral was much like it would be for us except bodies are not prepared for burial.  The funeral occurred within 24 hours after the accident.   When we returned to Iringa we passed the Kising'a bus which had been in a terrible accident.  Sue and I have taken the same bus back from Kising'a in the past and several people were killed with many injured.  There will be more funerals in the villages this week.

Full car going to Kidumuka

Graveside

Returning after the service

2017 Ilula Minnesota Healthcare Conference

As you have already read, last Thursday and Friday were devoted to presenting our fourth annual Ilula Minnesota International HealthCare Conference.  Starting in 2014, Shoulder to Shoulder has presented the annual conference for our colleagues in Tanzania.  All our presenters did a great job and all the healthcare professional teams that attended gave positive feedback and will return to their hospitals with quality improvement plans to implement based on what they learned.

Our first course was presented in January 2014 with 30 attendees.  Based on extremely positive feedback from the initial conference, our partners in Tanzania encouraged us to significantly expand the conference to offer this educational experience to a much larger audience of caregivers.  As a result, we expanded the 2015 conference to include all 28 Southern Zone Lutheran Hospitals and hosted 100 professionals.   From each hospital we invite one doctor, one nurse and one pharmacist and one administrator.  They come as a team and together develop quality improvement plans at the end of the conference which they will try to implement when they return home.  Again this year we hosted over 100 Tanzanian health care professionals at the conference.

Our conference is based on 5 principles:

1. Lifelong Learning.  We believe all professionals should contribute to a culture of learning and continuously learn to improve our practice.  We include students and residents in preparation and presentation of the conference.
 2. Interprofessional teamwork.  We include nursing, pharmacy, administrators, and physicians in both the attendance and presentations.  We emphasize teamwork throughout the conference.  We each bring unique knowledge and skills to share; specifically Tanzanian presenters emphasize tropical medicine and HIV, American presenters emphasize the growing global problem of chronic and non-communicable diseases.
3. Mutual Respect.  We emphasize the ability for all our participants to teach and learn from each other, in spite of our differences in practice setting, culture, and socioeconomic situation.  We include local leaders in planning the conference and select topics based on feedback from participants.  Presentations are delivered by both US and Tanzanian professionals.  We adhere to the highest international standards in the preparation of the educational content and accreditation of the program.  The program is based on a foundation of a longstanding and ongoing relationship.
4. Continuous improvement.  Learning should drive improvement in practice.  We include planning sessions for participants to complete planning documents based on learnings to institute improvement plans upon returning to home hospitals.
5. Sustainable Impact.  We believe that education and improvement are some of the most valuable ways to promote a sustainable positive impact on the health of our partners’ communities.

Our conference is accredited by the Education Department at the HealthEast Care System to provide participants with CME credits for participation in this program, and the University of Minnesota International Medical Education and Research Program.

Funding for the course is provided through generous contributions from several foundations and individuals including Global Health Ministries and the Peter King Family Foundation.  All funds raised go entirely to hosting the conference, and support for local Tanzanian staff to attend, including meals, travel and lodging expenses.  We want to thank all our donors including Global Health Ministries, The Peter King Family Foundation, Dale and Patty Anderson, Arlene and Dave Tourville, and others.  We were excited this year to be visited by several representatives from the King Foundation on Friday.

Overall the conference was a great chance to learn together, build relationships, and plan together to improve healthcare in Tanzania.

Tungamalenga and Ruaha National Park

Hello friends of Ilula!

This is Katie Keyworth blogging, but the signal here is not too strong so I didn't want to chance logging out David and logging myself back in.

After a successful 4th annual TZ-MN Medical Conference our group set out on the journey to Tungamalenga (companion church of Shepard of the Valley). When we arrived Saturday we met with Pastor Eva and others to go out to 2 preaching points. Both preaching points are Massai, which is a certain tribe that are traditional nomadic and raise cattle. 2 of our men, David and John (Medical Resident) were invited to join in a traditional manhood ceremony where the men compete to see who can jump the highest. They must have done okay because apparently they now share 3 wives and 7 children.

Sunday morning after stocking the pharmacy at the dispensary (clinic)  with donated medicine, we attended a very lively and musical church service. David and I were invited to dance with the youth choir. There was a lot of laughing; not sure if it was with us or at us, but either way it was a blast.

After a delicious lunch it was time to head out to Ruaha for safari. We took a game drive to our camp, Mwagusi. I could write for hours about all we have seen, so I will try to sum up. We all got to see a pride of lions with 4 cubs and 2 females. They were playing and having bathtime in the shade. We were also really lucky to see a leopard hunting from atop some rocks! One car got to see a stampede of elephants, possible running from poachers, that numbered close to 200!! Other great sights include baboons, giraffes, zebras, impala, hippos, crocodiles, and over 35 species of birds.

Tomorrow morning we will have a bush lunch and leave the park to return to Ilula.

The Fourth Annual Ilula-Minnesota Healthcare Conference, Day 1

It has been a bit of a whirlwind over the past few days and the new group is a little behind on blog entries.  So I will minimally try to bring up the slack.

When I arrived just after 8 AM at the Primary Health Care Institute (PHCI), there were many attendees already present, chatting and waiting for it to begin.  I wasn’t long until the Ilula crew arrived, however and dug in to registration and set up.  I got the new projector set up and felt pretty smug that the files were all organized and present on the ol’ 2008 Mac Book and raring to go.  Oh, that new projector is nice! 

Colleagues were putting out the sign-in sheet and distributing snazzy packets, each with a notebook, a couple evaluation sheets, a pen (Blue Pilot G-2 07) and a USB drive with all the lectures and handouts on it.  (There was applause for that!)  That made access to the info much easier and the drives have lots more room for storage.

After all were properly signed in and formal introductions made, Rev. Peter Harrits gave an insightful meditation and invocation, comparing the attendees to the devoted and faithful caregivers of the man lowered through the roof so Jesus could heal him.  This is an apt description of the hospital staffs at the conference, clinicians, nurses, pharmacists, administrators, nursing school principals and others.  Each and every one of the presentations was excellent!  And more to come tomorrow.  We were honored to have a guest speaker, Dr. Jose Debes who capped off the day.  All the talks were excellent and Louise Myers gave an outstanding keynote.  The other speakers for today and tomorrow are listed to the right, since they are also the blog authors and conference faculty.

Our faculty and attendees were honored by a group from Gustavus Adolphus College on interim, led by veteran African traveler Barb Zust, who brought her guitar-playing brother as accompaniment for the groups excellent mini-concert.  The entire audience loved it!

There are photos to post too, but that will wait a day or so!

Ken

Saturday in Ilula

After a busy and fun day in Iringa yesterday the group had a quiet "catch-up day" around the house in      Ilula. A heavy downpour filled the huge rain buckets around the house but we were still able to do a wonderful late afternoon walk through some of the surrounding countryside. Medical rounds were made on the most serious patients. A pediatric HIV-AIDS Clinic saw approximately 70 children and the nursing school, in a pre-registration informal survey received a very encouraging prediction that the formal registration survey will go well in a couple of weeks.
Hospital administration issues that have received attention this past week and will continue to be a focus next week include the introduction of a Medication Administration Record to reduce medication errors, the introduction of Incident Reporting for quality improvement and the introduction of the WHO Guide to Medical Records for Developing Countries, a useful tool for improving the content and organization and tracking of medical records throughout the hospital.
Louise Myers

A Visit to Iringa and all things Ilula

Another remarkable day.  Really.  We began the day with Anna's remarkable Mendazi (sp!) which are essentially fried donuts and so delicious.  Morning report was quite interactive between the Muzungu and Tanzanians- we discussed several patients including a patient that was quite rare for Ilula- a smoker.    Fortunately, most Tanzanians do not smoke- so refreshing.
The Pharmacy students settled into the CTC for HIV management as did I.  Dorine is the new Pharmacy Technician for the CTC and reports that Ilula has more than 4.000 HIV patients.  In followup for the supply source of the anti-retrovirals, they come from Global Health.  The best I can tell is that Global Health is a consortium of sorts for countries in need.  Frank Sanga reports that this group supports multiple programs including reproductive health, malaria and HIV.  Frank provided us with a wonderful tour and overview of his scope today including his narcotic process.  Shockingly, in order to procure oral morphine, he personally has to drive to Dar Es Salaam twice a year to purchase; this is an in-person process only, no other methodology is allowed.
Personal bucket list item for me today that I briefed the students about:  had a dress made!  My dear rafiki Rita helped me find a great tailor and I had a blouse and skirt made in Tanzania style by the pastors wife who is also a tailor.  The pastors wife is pregnant and Margaret helped me make a knit cap for the new baby as an additional gift.  So fun!
Spent the afternoon in Iringa and had a lovely meal at Mama Iringa- delicious lasagna and pizza and lots of fun.  Everyone had a chance to visit a few fun places in addition to Mama Iringa :  Mesai Village and Neema Crafts.
Love Iringa.  Love Tanzania.  Love the students and our wonderful group of learners and cultural experimenters!

It’s a revolution that brought singing to us!

Some of the visiting nursing students

Habari za jioni kukota Ilula! (Good evening from Ilula). Today started out slow as it was a public holiday for all Tanzanians. It is a day off to celebrate the Zanzibar Revolution. We did not have our usual devotion and medical report that would occur every morning prior to rounds. However, it turned out to be a great morning as undergraduate students from Gustavus College Minnesota were visiting us. We were able to spend about 3 hours with them prior to rounds. The visiting students came ready with their singing voices and instruments. We started out with Randy giving them a quick overview of our program. I, Lauren, Lisa and Margaret then talked about our medical and cultural experiences so far. The students were very engaged in this process and asked lots of great questions. We then turned it into a circle of sharing. All the visiting students as well as our team here in Ilula shared our most shocking, rewarding or stand out experience so far. The experiences that the visiting students have had so far included; observing the way faith and hope are integrated into healthcare provision here in Tanzania, visit to palliative care facilities, visit to the Masia girls school, visits to the Pastors house to see kids with disabilities such as cleft lip and palate getting care and also lots of singing in medical wards to encourage the patients.

Our circle of sharing

After we got the chance to hear from everyone about their experiences and what they will take back home to the USA with them, we then got to hear the students from Gustavus sing. Interestingly, Todd (one with the guitar pictured below) who is the pastor on this trip with them teaches them songs in Swahili which he learned from a Pastor in Minnesota that conducts 2 pm Swahili services on Sundays. How cool is that?

Gustavus students singing for us! Lovely

We provided a tour of the facility to them and after the tours, they sang to patients in the Labor and delivery ward as well as the general ward. The song they sang was very beautiful and this was a huge part of their healing message to the patients. The patients really appreciated this.

We then received a grand tour of the nursing school and took a picture as shown below.

Gustavus students in the Nursing school

We said our goodbyes to the Gustavus team as they continued on their amazing exploration and singing J-term global experience in Tanzania.

The rest of the team went ahead on rounds with the few doctors that were present today and lots of eager and sharp looking nursing students.

Side note: the nursing students here are great and are very eager to learn. They were pretty much running the show today as it was a public holiday and not all the staff nurses were present. They are such a lively and amazing group of students and one of the faculty also mentioned how interactive they are in class.

We rounded up the didactic day with discussions on the porch with the amazing view of the mountains. We discussed altered mental status and HIV overview. Randy gave us a great tool for assessing and managing patients with altered mental status and Michael gave a great overview of HIV/AIDS.

Amazzzzzing views!!

We ended the day with a long walk through town and explored some new areas of town. We stopped by the local pub (previously the Peace Garden) to wait for our scheduled dinner time with Dr. Saga. The weather was fantastic so we sat outside.

Some members of the team at the local pub enjoying the lovely weather

We stopped by Dr. Saga’s for dinner made by his beautiful wife Anita. The meal was delicious and we were very grateful for this amazing time. Dr Saga devoted his 30 year plus career to the Ilula Lutheran Hospital and has been such a great partner for this program. He is currently retired from the hospital but runs a Duka La Dawa (pharmacy) near his home. He is also still involved in planning our Annual Minnesota-Ilula Medical conference coming up next week.

It was indeed another great day in Ilula. Tomorrow we will be going into town to explore the markets in Iringa town and continue to perfect our kSwahili. 

Kwaheri!

Good bye for now.