tag:blogger.com,1999:blog-2684979583510506412024-03-05T08:18:06.185-08:00Ilula-Friends-2017Kenhttp://www.blogger.com/profile/08062952252731045537noreply@blogger.comBlogger29125tag:blogger.com,1999:blog-268497958351050641.post-69872064015124936172019-12-30T09:44:00.000-08:002019-12-30T09:44:35.745-08:00Jill's Reflections before leavingGetting very excited to see old friends in Ilula and meet new friends from our group! Looking forward to showing our PharmD students all that Ilula, Iringa and Tanzania has to offer- the experience is so rich and rewarding. My next challenge is to pack VERY light- I always say that but somehow.....One suggestion for the team is to bring a few snacks for the bus- protein bars, beef jerky and of course sweet things work well too. It is amazing how a taste of home can quell a tired or unfamiliar feeling on the journey. Jill Stryhttp://www.blogger.com/profile/15396807442570936564noreply@blogger.com0tag:blogger.com,1999:blog-268497958351050641.post-42422529568895024782017-02-12T06:22:00.002-08:002017-02-12T06:22:49.899-08:00Maasai Preaching Point Photos <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpxutWv-nSYxIhFPCxROgjrKSU7cSjOaKGZeQOKNtF9IWrllTSSIIr5vB5qDZoz8ckmEButi6nZmg_2kDk0bybU9lbVOdaX_ZJS2_NVnYwpctb5MZS01RQyapSBWc_AqrUVO-Yb5xWQqIX/s1600/IMGP3530.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="265" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpxutWv-nSYxIhFPCxROgjrKSU7cSjOaKGZeQOKNtF9IWrllTSSIIr5vB5qDZoz8ckmEButi6nZmg_2kDk0bybU9lbVOdaX_ZJS2_NVnYwpctb5MZS01RQyapSBWc_AqrUVO-Yb5xWQqIX/s400/IMGP3530.jpg" width="400" /></a></div>
They sang and danced for us.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbYVoFAAPTGe4ZO1I_IS1xvM6Df6Ase__oJxJBxYuC2khyhRaWVP5lMNOaTy_1PdR1uEJoARsiLdafbtEy6UxWips_70Lq8F8oit6FTH7O77-yRkMpPE5qgr47zDhyphenhyphenjYXotDe95ycqjLfV/s1600/IMGP3534.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="265" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbYVoFAAPTGe4ZO1I_IS1xvM6Df6Ase__oJxJBxYuC2khyhRaWVP5lMNOaTy_1PdR1uEJoARsiLdafbtEy6UxWips_70Lq8F8oit6FTH7O77-yRkMpPE5qgr47zDhyphenhyphenjYXotDe95ycqjLfV/s400/IMGP3534.jpg" width="400" /></a></div>
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What a basketball player!<br />
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The men danced for us. Wow can they jump!<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBhxujN06D400LmqW87IRjOmVHf7CZJgJBB4fJw8Qdi1dbTeUx24z2D3sIqKFOdOCnQCbmsmtJ8S_uWusyj17ueVFFwqxqoY9YZAk9KLbbiRAXuNVehcse0-PXb1H98Sa6uJWD9SLDMZkq/s1600/IMGP3546.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="265" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBhxujN06D400LmqW87IRjOmVHf7CZJgJBB4fJw8Qdi1dbTeUx24z2D3sIqKFOdOCnQCbmsmtJ8S_uWusyj17ueVFFwqxqoY9YZAk9KLbbiRAXuNVehcse0-PXb1H98Sa6uJWD9SLDMZkq/s400/IMGP3546.jpg" width="400" /></a></div>
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A couple of our own level-headed women! Mahveen ^ and Lauren -><br />
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Above, the men danced for us. The women responded in like manner. Well, not with the high jumping, but up close and personal, for sure.<br />
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And they are tall too!<br />
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Ndio, Tanzania, mimi nakupenda!Kenhttp://www.blogger.com/profile/08062952252731045537noreply@blogger.com0tag:blogger.com,1999:blog-268497958351050641.post-67088491704960459892017-02-11T01:31:00.000-08:002017-02-11T01:31:58.883-08:00The Close of our 2017 Ilula Medical Experience<style>
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As deeply as the death of our smallest charge affected me
personally, I cannot let that be the last entry in the blog.<span style="mso-spacerun: yes;"> </span>A couple others are on the list of
contributors, but I know they are consumed by travel weariness and jet
lag.<span style="mso-spacerun: yes;"> Hopefully, they will add their reflections too. </span>Thankfully, Dan McIntyre notified
me that our intrepid travelers, you recall AKA “the fun group,” arrived home
unscathed, though not without a little scare when two nearly missed the plane
in Amsterdam.
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Birdie and I remain in Iringa until Friday when we will
indulge in a new experience and fly from Iringa to Dar es Salaam.<span style="mso-spacerun: yes;"> </span>As an aside, we have contemplated using this
transport both ways, to and from Iringa to Dar.<span style="mso-spacerun: yes;">
</span>However, we tend to bring significantly extra baggage that does not
return home with us, e.g. computers thanks Dan, Gary and Margaret!), some
medical supplies, scrub suits intended to be left behind, this year hospice
kits (thanks Jill Strykowski and Allina Friends!) and quilts for the new
nursing student class, a donation of 17 stethoscopes (thanks Dan and Sue
McIntyre and 3M!), 2 soccer balls, (Dan and Sue), some resuscitation equipment
(thanks Jon Koratoff and Nadia Juneja), education supplies from Lauren Turner’s
boyfriend’s church (Mike, I hope).<span style="mso-spacerun: yes;"> </span>And
that was just with the fun group and with apologies to those I may have missed! <span style="mso-spacerun: yes;"></span>So it
should be apparent the difficulty we would have on the entrance trip.<span style="mso-spacerun: yes;"> </span>And the group would miss the thrill of Mikumi
National Park and the surprise of seeing African animals up close for the first time.</div>
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All in all, it was a terrific experience for me as
always.<span style="mso-spacerun: yes;"> </span>I miss being with the larger
group more.<span style="mso-spacerun: yes;"> </span>Cannot be helped, I suppose,
being relegated to the fun group.</div>
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We (the collective, not the Royal) continue to learn things
as our experience grows. Well, duh, you say. Me too.<span style="mso-spacerun: yes;">
</span>As an experiment this year, because in the end we had the room, we had a
couple non-medical personnel with us.<span style="mso-spacerun: yes;"> </span>As
always, this had some unexpected consequences.<span style="mso-spacerun: yes;">
</span>Dave diligently walked daily to the Ilula Orphans Program (IOP) where he
learned vernacular Kiswahili and worked hard.<span style="mso-spacerun: yes;">
</span>Dan made forays to several schools and was the resident computer expert.
Obviously these were highly useful things to do, but could be done anytime
other than the medical trip.<span style="mso-spacerun: yes;"> </span>We have had
students in the past who stayed at IOP and occasionally visited us, an altogether
different experience. </div>
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This time after the official experience has inspired, or perhaps incited, the
contemplative side of me.<span style="mso-spacerun: yes;"> </span>I am trying to
write a “Code of Conduct,” and also a specific waiver regarding use of the public
transportation.<span style="mso-spacerun: yes;"> </span>Having a coaster bus at
our disposal, mostly unused on a daily basis, is a burdensome expense; our
travelers have been quite insistent that they want to ride public
transportation. Yet our biggest risk in Tanzania is (motor vehicle) accident,
not TB, HIV, malaria or the other maladies we tend to worry about (not even
Zika or Ebola).<span style="mso-spacerun: yes;"> </span>Bummer, since the
crashes are virtually all preventable.</div>
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I will end on a high note. Once again, the trip was
rewarding and memorable for me. <span style="mso-spacerun: yes;"> </span>My hope
is that our crew feels the same way!<span style="mso-spacerun: yes;"> </span>We
have met lifelong friends here in Tanzania that we look forward to seeing every
year.<span style="mso-spacerun: yes;"> </span>I truly hope my path crosses those
of all our travelers’ soon and often in the future! </div>
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Enjoy the photos below! Or above. I will publish them separately, since Blogger is misbehaving.<br />
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Kenhttp://www.blogger.com/profile/08062952252731045537noreply@blogger.com0tag:blogger.com,1999:blog-268497958351050641.post-33594046686549095462017-02-06T00:55:00.000-08:002017-02-06T00:55:08.819-08:00The Baby Died
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Just back from the toughest morning report since I have been here, especially
in contrast to the celebratory atmosphere as we gave some of the things we
brought: protective eyewear – we need to bring these annually, scrubs - always
welcome for the OR, miscellaneous alcohol wipes, gloves - non-sterile and
sterile, etc. Dr. Sovelo was presented with a couple good 3M diagnostic
stethoscopes for distribution. And all these things bringing kudos from our
colleagues.
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Those leaving had an opportunity to say thanks and
goodbye.<span style="mso-spacerun: yes;"> </span>I was pleased to offer
appreciations to the staff for their good work and pointedly let them know they
are role models for the nursing students.</div>
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Then we heard morning report.<span style="mso-spacerun: yes;"> </span>First, a man died in the night.<span style="mso-spacerun: yes;"> </span>He had complained of chest pain earlier and
multiple other problems, including HIV at age 36, which was why he was admitted.<span style="mso-spacerun: yes;"> </span>His death diagnosis was asystole.<span style="mso-spacerun: yes;"> </span>It happens.<span style="mso-spacerun: yes;">
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Next, we heard what none of us wanted or expected to
hear.<span style="mso-spacerun: yes;"> </span>Our eight-month old patient,
Adonis, with the severe malnutrition (marasmus) had died.<span style="mso-spacerun: yes;"> </span>We all thought the baby looked slightly
better after getting therapy started.<span style="mso-spacerun: yes;"> </span>We
learned some additional history too.<span style="mso-spacerun: yes;">
</span>This was at least the third time the infant had been admitted to the
hospital, the first two times at the Regional Hospital in Iringa.<span style="mso-spacerun: yes;"> </span>Despite the efforts we made, he had a couple
chances before he reached us. Did someone drop the ball at Iringa? This is
information we cannot know.<span style="mso-spacerun: yes;"> </span>It is
tempting to climb the ladder of inference, but there are so many
explanations!<span style="mso-spacerun: yes;"> </span>Was this an unwanted
baby?<span style="mso-spacerun: yes;"> </span>Munchausen’s by proxy? Poor care
at the Regional Hospital? Inadequate resources? Inadequate teaching? All of
these things?</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
All I can say is I am deeply saddened at our failure to save
this child, but perhaps it was inevitable. I know he would not have died in the
US.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
To make things worse, if they could be worse, Sovelo had a
disaster too.<span style="mso-spacerun: yes;"> </span>A woman with 2-3 previous
C-sections and only two prenatal visits, presented in labor, an indication for
emergency surgery.<span style="mso-spacerun: yes;"> </span>The nurses noted
fetal heart tones (FHT).<span style="mso-spacerun: yes;"> </span>Unfortunately, at
surgery, Sovelo found extensive adhesions (scarring) that made access to the
uterus very difficult.<span style="mso-spacerun: yes;"> </span>He delivered a
macerated baby, indicating previous intrauterine fetal demise.<span style="mso-spacerun: yes;"> </span>The baby was grossly deformed, with brain,
meninges and heart malformations externally visible.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
That tragedy was not enough.<span style="mso-spacerun: yes;">
</span>The mother had severe bleeding. With heroic effort, Sovelo got that
stopped, some blood transfused, the uterus removed, and the woman transferred
to the Regional Hospital.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The case prompted a tirade from one of the nurses about
patients who do not do what we say is best for them.<span style="mso-spacerun: yes;"> </span>This happens at home too: competition between
the medical professional principles of primacy of the patient, autonomy of the
patient, and social justice, sometimes causing a clash that may be
unresolvable.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The FHT disparity raises questions too. <span style="mso-spacerun: yes;"> </span>Obviously, the baby had died before the FHT
were recorded as present. What is the explanation? Shortcut? Lack of
synchronization with maternal pulse? (This was kindly Sovelo’s explanation.)
Again, it is difficult but essential not to climb the ladder of inference.<span style="mso-spacerun: yes;"> </span>Handheld electronic Doppler Ultrasound fetoscopes
may not be the perfect answer, however, they are durable, portable, reliable, quick
and pretty inexpensive – under $100, I think.<span style="mso-spacerun: yes;">
</span>Perhaps ILH should have one or two and each of the eight Lutheran
Dispensaries should have one also.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We will debrief these cases this evening, perhaps mainly for
reflection.<span style="mso-spacerun: yes;"> </span>Now we have all seen such
cases in our experience here.<span style="mso-spacerun: yes;"> </span>Still I
had a lot invested personally in the case of Adonis.</div>
Kenhttp://www.blogger.com/profile/08062952252731045537noreply@blogger.com0tag:blogger.com,1999:blog-268497958351050641.post-40191679985760232792017-02-02T07:34:00.000-08:002017-02-02T07:34:10.300-08:00A Mixed Blessings Birthday
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<br />
<div class="MsoNormal">
<br /></div>
I am writing this the day before my birthday and my
coincidentally assigned blogday. Perhaps I will make an addendum.
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Today I went rounding with Dr. Benjamin.<span style="mso-spacerun: yes;"> </span>He had already begun his work. Others of the
team were distributed amongst the various other ILH functions so I was with him
by myself.<span style="mso-spacerun: yes;"> </span>I heard there was a child
with a substantial burn that I was anxious to see.<span style="mso-spacerun: yes;"> </span>He had basically finished with the little
girl. I decided to take a peek. The 3 1/2 year old girl had somehow splashed
boing water on herself.<span style="mso-spacerun: yes;"> </span>This is a very
common problem in TZ.<span style="mso-spacerun: yes;"> </span>The wood or
charcoal stoves are low to the ground and sometimes the pots tip.<span style="mso-spacerun: yes;"> </span>There was an infant that died of an extensive
burn a week or so ago.<span style="mso-spacerun: yes;"> </span>Fortunately, this
little girl has mostly superficial second-degree burns with some deep second
degree, about 18% body surface.<span style="mso-spacerun: yes;"> </span>Of
course, the important concept in treatment is to keep the second degree burns
from becoming third degree, i.e. full thickness burns.<span style="mso-spacerun: yes;"> </span>They know what they are doing here. If only
there were fewer of them to know about. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I tried to make myself helpful and saw a couple kids with
respiratory problems.<span style="mso-spacerun: yes;"> </span>Both were stable;
both had pneumonia. Both should do fine.<span style="mso-spacerun: yes;">
</span>We moved on.</div>
<div class="MsoNormal">
<br /></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCzeyTXxsxA8u6PLq9ewXqk2wb41dqb0968HvgLuQNv0kjmjzgaofOP7jUWCbwfTmvzYELzKj2fvO8UQqOc3LhIZ9xk7-k1JMTXxYr-TMUt3DvPRkj0ZjOTMh_Dj-JXCPEFI91yvlY-aaL/s1600/Adonis.jpeg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCzeyTXxsxA8u6PLq9ewXqk2wb41dqb0968HvgLuQNv0kjmjzgaofOP7jUWCbwfTmvzYELzKj2fvO8UQqOc3LhIZ9xk7-k1JMTXxYr-TMUt3DvPRkj0ZjOTMh_Dj-JXCPEFI91yvlY-aaL/s320/Adonis.jpeg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The Growth Chart</td><td class="tr-caption" style="text-align: center;"><br /></td></tr>
</tbody></table>
<div class="MsoNormal">
In the next room we went to, there was a baby, an eight
month-old who was sick.<span style="mso-spacerun: yes;"> </span>The mama was
young – I do not know how young at the moment – and accompanied by bibi
(grandmother).<span style="mso-spacerun: yes;"> </span>I am not even sure why
mama brought the child in now and not last week or last month. The baby has
marasmus.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
About 38% of children under-five years of age in Tanzania
are stunted, i.e. short for age.<span style="mso-spacerun: yes;">
</span>Stunting is a surrogate or indirect measure of chronic under-nutrition.<span style="mso-spacerun: yes;"> </span>Wasting, low weight-for-height, is a measure
of acute under-nutrition. (Remember that obesity is also malnutrition.)<span style="mso-spacerun: yes;"> </span>Marasmus is the extreme case of wasting.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The mother had never breastfed the infant.<span style="mso-spacerun: yes;"> </span>Dr. Benjamin speculated lack of counseling on
discharge from the hospital. Did she leave early? Did she just get missed? She
had told someone that her milk did not come in.<span style="mso-spacerun: yes;">
</span>A wives’ tale, or should I say “Bibi’s tale,” is that colostrum is
harmful.<span style="mso-spacerun: yes;"> </span>Was she discouraged in this
fashion?<span style="mso-spacerun: yes;"> </span>Attempted and persistent
nursing is what stimulates milk production.<span style="mso-spacerun: yes;">
</span>What happened?<span style="mso-spacerun: yes;"> </span>Perhaps we will
find out as a few days roll by, but my language barrier will obstruct me from
finding out easily.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I do not know what he has been fed. Possibly only dilute
ugali.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Marasmus kids look like little old men or women.<span style="mso-spacerun: yes;"> </span>The face is drawn, Adonis’ face is drawn and
tiny.<span style="mso-spacerun: yes;"> </span>Their ribs stick out.<span style="mso-spacerun: yes;"> </span>My colleagues noted, “You can count his
ribs.” His arms and legs are sticks.<span style="mso-spacerun: yes;"> </span>His
lips are dry and cracked. A rash is peeling the skin away on his posterior
thighs.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The last case of marasmus I saw, a two year-old girl, died
within two hours of admission.<span style="mso-spacerun: yes;"> </span>Kelsey
Watt, do you remember her? I know you do! Her picture, which has haunted me for
several years, is now replaced by that of Adonis. Yes, I am using his real name
and no apologies.<span style="mso-spacerun: yes;"> </span>If he survives and I
see him again in a year, perhaps I will apologize. Or just hug him.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Ashura, one of our nurses, is the local authority on
malnutrition and knows just what to do.<span style="mso-spacerun: yes;">
</span>We recruited the nursing students for round-the-clock attendance to help
with feeding and to watch for re-feeding syndrome, intolerance of formula.<span style="mso-spacerun: yes;"> </span>I went back to the room this evening.<span style="mso-spacerun: yes;"> </span>The nurses have washed him and lubricated his
lips. I got to hold him for a few minutes. I told him, “I am Babu,”
grandfather.<span style="mso-spacerun: yes;"> </span>I will be on edge until I
know he has started improving.<span style="mso-spacerun: yes;"> </span>This
morning, my actual birthday, I am relieved and happy to report that he looks
qualitatively better. This afternoon, no diarrhea and no vomiting, the latter
the important sign of re-feeding syndrome.<span style="mso-spacerun: yes;">
</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This morning we heard the second year Nursing Students
report out on their field experiences.<span style="mso-spacerun: yes;">
</span>The three teams each went to a separate communities where they lived for
4 weeks, assessing the community’s health needs.<span style="mso-spacerun: yes;"> </span>They all did a marvelous job – in English.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
On a further happy note, we are having a get-together for
the entire staff tomorrow (now today).<span style="mso-spacerun: yes;"> </span>I
volunteered for our group to pay for the sodas and water. That was before I
knew there are close to 180 people, including nurses, doctors, aids,
volunteers, housecleaning staff, guards, nursing students and tutors and us.<span style="mso-spacerun: yes;"> </span>It was also before Kikoti suggested two
bottles each.<span style="mso-spacerun: yes;"> </span>Originally I coined it a
“Soda Party.” I had not connected it with my birthday.<span style="mso-spacerun: yes;"> </span>Still it is more apt as a going-away party,
since Jon and Mahveen will leave Saturday and the remainder will leave Tuesday
next. I will stay on in Iringa with Birdie for another 10 days.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
An update on the Soda Party. I am pretty sure it was the
biggest thing at ILH since Saga’s wedding, which was BIG!<span style="mso-spacerun: yes;"> </span>OK, so that was at the church, not the
hospital, but anyway, it was BIG.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There won’t be any photos of Adonis.<span style="mso-spacerun: yes;"> </span>You may look at the growth chart, however.<span style="mso-spacerun: yes;"> </span>Note that his weight had crossed many
lines.<span style="mso-spacerun: yes;"> </span>I am not sure why the baby was
not sent for consultation at any point in the past.<span style="mso-spacerun: yes;"> </span>Possibly he was.<span style="mso-spacerun: yes;"> </span>There could be a myriad reasons why nothing
happened.<span style="mso-spacerun: yes;"> </span>Perhaps I will find out. Maybe
not.</div>
<div class="MsoNormal">
<br /></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijMLCz43IPuS6psZRxoH_avSHZiMvcWN8mjg2mnKB5ozhyphenhyphenfYRDLpeSnW9mWjfnH0US4ZXXSA5O2PDdSyNKrQEpp9wC0RfXaezP2VnNWX6_Cs4eMgwF21MxbQCWM7wbNtdfTpq0paLtC63_/s1600/Photo+Feb+02%252C+4+16+58+PM.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijMLCz43IPuS6psZRxoH_avSHZiMvcWN8mjg2mnKB5ozhyphenhyphenfYRDLpeSnW9mWjfnH0US4ZXXSA5O2PDdSyNKrQEpp9wC0RfXaezP2VnNWX6_Cs4eMgwF21MxbQCWM7wbNtdfTpq0paLtC63_/s320/Photo+Feb+02%252C+4+16+58+PM.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Tanzanian line dance</td></tr>
</tbody></table>
<div class="MsoNormal">
I have a party crowd photo from my birthday party – I mean,
the “Soda Party.” You can pick out what you see as blessings above. You should
include the birthday present I got from the nursing students, kobe in Kiswahili
or turtle in Kingereza.<span style="mso-spacerun: yes;"> </span>I am contacting
Mr. Magafuli for special dispensation to bring him (kobe) home.<span style="mso-spacerun: yes;"> </span>I am tweeting Mr. Trump.</div>
Kenhttp://www.blogger.com/profile/08062952252731045537noreply@blogger.com0tag:blogger.com,1999:blog-268497958351050641.post-4105401212604432922017-02-01T09:42:00.002-08:002017-02-01T09:42:30.676-08:00Tadaaahhh! <div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: Times; font-size: 16.0pt; mso-bidi-font-family: Times;">This post is dedicated to the student project that
Prosperity and I have created in hopes of bettering the communication among the
appropriate staff at Ilula Lutheran Hospital. Throughout our time at the
hospital, which expanded to approximately three weeks, we have realized a flaw
within the hospital regarding laboratory test availability and lack of
communication regarding this issue. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: Times; font-size: 16.0pt; mso-bidi-font-family: Times;">When Prosperity brought up this issue at one of our
discussion meetings, we had decided to brainstorm ideas for resolving this
issue within the communication process. Specifically, we had discovered that
some staff members (clinical officers, doctors and nurses) were not fully aware
of all of the laboratory tests that were offered at the hospital. Among that
issue, we became aware that many of the lab tests that normally are available
were not able to be measured due to various issues (reagent out of stock or
unavailable, machine broken, etc). Therefore, much of the staff were not aware
of the lab tests that were or were not available. During inpatient rounds, we had
observed that certain labs would be ordered, then the following day would not
have been completed. After much questioning, we discovered that certain lab
tests could not be completed due to both reagents being out of stock and the
machine to run certain tests was broken. Therefore, the communication system
between some medical staff (doctors, clinical officers and nurses) and the
laboratory staff was flawed. <o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="table of authorities"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="macro"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="toa heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 5"/>
<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Closing"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Signature"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Message Header"/>
<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Salutation"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Date"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="FollowedHyperlink"/>
<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
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<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
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<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
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<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
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<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/>
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<span style="font-family: Times; font-size: 16.0pt; mso-bidi-font-family: Times;">In order to get a better idea of how this issue
could be resolved, we decided to talk to Emmanuel, the District Laboratory
Manager, to hear his opinions regarding the issue. Fortunately, he was
able to find some time in his busy schedule to meet with us and the Ilula
Laboratory Manager, Naftal. We discussed the problem<o:p></o:p></span><span style="font-family: Times; font-size: 16pt;">s that we have noticed in
our time at the Hospital. Both Emmanuel and Naftal agreed that this communication
gap was largely a “failure in system tracking” that needed to be resolved for
the betterment of the hospital and staff. After a very informative meeting with
Emmanuel and Naftal, we decided that we had enough information to kick start
our project with approval from them. This project was completed with the
understanding that it would be easy enough to update on a weekly basis and
continue after we had left the Hospital. Prosperity came up with the brilliant
idea of creating a board called, “laboratory testing availability.” The idea of
the board is to not only have all the available lab tests at the hospital, but
also have the information regarding stocking (in/out of stock) and any other
important information (example, CD4 – out of stock – reagent out). This white
board can be easily updated weekly and can be presented to the medical staff
during morning report. We are very excited to present this project to Emmanuel
and Sovelo, the medical officer in charge at Ilula Hospital. This project will
hopefully bridge the gap in communication between the laboratory staff and the rest
of the medical staff and it is amazing to have Emmanuel and Naftal happily on
board with it.</span></div>
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-268497958351050641.post-35393855964904928572017-02-01T08:54:00.000-08:002017-02-01T08:54:34.211-08:00Final Supervision Visit for Second Year Nursing Students <br />
Lauren and I had the pleasure of traveling with Tuli and Anifa, the nursing school teachers, to visit the second year nursing students for their final supervision visit. Although it was a long day of travel, the scenery surrounding us was absolutely breathtaking - which made the time in the car that much more worth it!<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtnhO3A7lMHdN2WMa-aLgjyyzgTPIsCFGMk-kUyc2Iz1icSUcnV_9mH0_slJL5rjqAq3vmVLbxeftgI7Iu5pQvmCAjisBUmTJWPK1N32fl9OJfoTWcK_Dtrpu0CbcIla43BXvDxt4XO4c4/s1600/IMG_4185.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtnhO3A7lMHdN2WMa-aLgjyyzgTPIsCFGMk-kUyc2Iz1icSUcnV_9mH0_slJL5rjqAq3vmVLbxeftgI7Iu5pQvmCAjisBUmTJWPK1N32fl9OJfoTWcK_Dtrpu0CbcIla43BXvDxt4XO4c4/s320/IMG_4185.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Loving the amazing views!!!!</td></tr>
</tbody></table>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSrBHb6NphocFZAeuoID5JOky4OAQwDP0j_1-WjEZMPIAK04o1xkPBMUoB2lFMefcIRLX-z_c0de8J7zw6NM6ovD0iIPNxiMAymgVjVnKatjye2vF8wIim7TVJYvH51Czv_i1mhbHdwaEx/s1600/IMG_4187.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSrBHb6NphocFZAeuoID5JOky4OAQwDP0j_1-WjEZMPIAK04o1xkPBMUoB2lFMefcIRLX-z_c0de8J7zw6NM6ovD0iIPNxiMAymgVjVnKatjye2vF8wIim7TVJYvH51Czv_i1mhbHdwaEx/s320/IMG_4187.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">So is Lauren!!</td></tr>
</tbody></table>
Our first stop was to visit the first three nursing students in a nearby village where the students were hard at work at the dispensary. We discovered that during the nursing students' four weeks at the site, that they had three different projects to complete that they would eventually be graded on. The first project was to either create or improve the labor room at the dispensary. The students were in charge of making sure the disinfecting material was properly changed and managed accordingly, labeling materials, and ensuring that the labor room meets appropriate code requirements. The second project involved improving the ease of use of the dawa (pharmacy). This was an especially meaningful portion of the trip, since the nursing school teachers requested our advice as to how the nursing students could improve the dawa. Some suggestions that we made included categorizing the medications into various sections (antihypertensives, antibiotics, etc.), labeling, and alphabetizing. We also suggested placing the bottles of the same medications in the appropriate order by expiration date where the date that is soonest would be in front and the farther off dates in the back. The third project was setting up hand washing stations at the teacher and student bathrooms and to make sure that they were in working order. The hand washing station was to be completely maneuvered by having a stick fashioned as a pedal to allow water to expel from the jugs so that hands could be kept clean and not contaminate the water jugs. The first site also took it upon themselves to complete a fourth project which was to find a new and clean water supply for a nearby section of the village. The teachers were very impressed by what the students had accomplished.<br />
<br />
After visiting for a short while, we then left the students and the nearby village to go visit the second group of students in the village of Udekwa. This village was within the mountains, so traveling there took a large amount of time, but was worth the journey since the scenery was so beautiful. Once we arrives, the students were graded on their similar projects. We shared lunch that the students had prepared for us, which consisted of delicious noodles and beans. Shortly thereafter, we visited the nearby primary (elementary) school where we met several of the students. Tuli took the opportunity at the end of the school day to make a speech about "working hard to accomplish goals and reach your dreams". We thought this portion was exceptionally moving. Once visitation was over with, we made our way back to Ilula with the teachers and stopped on the way to grab some cooking charcoal and plantains for the teachers. Overall, it was an amazing experience being able to see the students thriving and helping the community. It also was great to have the opportunity to contribute not only to the students learning but to the betterment of the dispensary and community.<span id="goog_41769434"></span><br />
Below are some photos of the projects the students were engaged in.<br />
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Thanks for reading!<br />
<br />
Prosperity and Lauren<br />
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<tr><td class="tr-caption" style="text-align: center;">In the Dawa_ Arranging the drugs</td></tr>
</tbody></table>
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<tr><td class="tr-caption" style="text-align: center;">Student's Hand washing Project</td></tr>
</tbody></table>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiquHuMesjokeF8bdUZ39KTk54Prhpz_emURwLZX7XOC557lGHCcRbulpHVZME6ddnO7Ob8vIU39CO8g6mgd1IB1Isgy7e4IE2dOPq5ziG-2Je6123SKb0fIRmONQ9LAaVJHD-2Wsh28ofU/s1600/2017-01-31-PHOTO-00000009.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiquHuMesjokeF8bdUZ39KTk54Prhpz_emURwLZX7XOC557lGHCcRbulpHVZME6ddnO7Ob8vIU39CO8g6mgd1IB1Isgy7e4IE2dOPq5ziG-2Je6123SKb0fIRmONQ9LAaVJHD-2Wsh28ofU/s320/2017-01-31-PHOTO-00000009.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">In search of clean water source for the village</td></tr>
</tbody></table>
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<tr><td class="tr-caption" style="text-align: center;">Sanitation buckets organized for the labor room </td></tr>
</tbody></table>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIEFNIwlXAUWE3_J-B5ts4uxtmxJEYXVRA7X0iS0mR_nmNTbfgXvJJgTV6Z8EM0pPEHuMWdED2ZgyDgTdhNuLIxCnZang2aZ3M0muDbMmVNkbu4JFEqbVX1nbAwBK-4w48KHOhugY0-X2S/s1600/2017-01-31-PHOTO-00000015.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIEFNIwlXAUWE3_J-B5ts4uxtmxJEYXVRA7X0iS0mR_nmNTbfgXvJJgTV6Z8EM0pPEHuMWdED2ZgyDgTdhNuLIxCnZang2aZ3M0muDbMmVNkbu4JFEqbVX1nbAwBK-4w48KHOhugY0-X2S/s320/2017-01-31-PHOTO-00000015.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Supplies organized for the labor room</td></tr>
</tbody></table>
<span id="goog_41769433"></span>Prosperityhttp://www.blogger.com/profile/18001354826514148198noreply@blogger.com0tag:blogger.com,1999:blog-268497958351050641.post-30210135455530245932017-01-29T07:39:00.000-08:002017-01-29T07:39:01.671-08:00Gathering with the Ilula Nursing StudentsAs 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.
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVsLjhMe_Jjomf3rSvIKjv0GDBbfbYw609RPJKic-hxKf1dt0ixVteCzz0c1R2AuX8aQ8aDceF90HLxpfdiR4NT6-IZj9tBZoSNdTFbHf_7VgXy08tFADtnsGYXHqpBxmlvsLNcZpOAqg/s1600/NursingStudentsDancing.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVsLjhMe_Jjomf3rSvIKjv0GDBbfbYw609RPJKic-hxKf1dt0ixVteCzz0c1R2AuX8aQ8aDceF90HLxpfdiR4NT6-IZj9tBZoSNdTFbHf_7VgXy08tFADtnsGYXHqpBxmlvsLNcZpOAqg/s400/NursingStudentsDancing.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">First year students African dance</td></tr>
</tbody></table>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoiLTViLP8NwtmxWESHO43nPWDZwnVpmJLwszSo7pOEO7Abs59ivjtqsiGDW_y7QLMCc2lc9DEScjxPylbgIrV9eW6vhYgQk3Viu3gM68wcwqJBYuW35PeQt7kHXL3WHiffdaJsFFJamA/s1600/NursingStudents.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoiLTViLP8NwtmxWESHO43nPWDZwnVpmJLwszSo7pOEO7Abs59ivjtqsiGDW_y7QLMCc2lc9DEScjxPylbgIrV9eW6vhYgQk3Viu3gM68wcwqJBYuW35PeQt7kHXL3WHiffdaJsFFJamA/s400/NursingStudents.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Photos with rafiki (friends)</td></tr>
</tbody></table>
Suehttp://www.blogger.com/profile/11690053265178310459noreply@blogger.com1tag:blogger.com,1999:blog-268497958351050641.post-88744578127108780672017-01-29T02:14:00.000-08:002017-01-29T02:14:00.812-08:00Friday in Ilula<!--[if gte mso 9]><xml>
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1/27/2017 (Pole sana! Late entry due to internet problems)<br />
<br />
The week came to a close with a mix of emotions… spent the last few days in
the inpatient wards. <span style="mso-spacerun: yes;"></span>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.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>A bedside thoracentesis was successful
removing almost 1.5 L of fluid... seeing the smile on his face was priceless.<span style="mso-spacerun: yes;"> </span>Eventually, I had to force him to rest and
stop hugging me in thanks.<span style="mso-spacerun: yes;"> </span>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.<br />
<br />
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.<span style="mso-spacerun: yes;"> </span>They had been
improving but suddenly worsened overnight and could not be revived.<span style="mso-spacerun: yes;"> </span>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.<br />
<br />
The days are flying by and can’t believe we’ve been here two weeks already.<span style="mso-spacerun: yes;"> </span>Excited to see what we learn from each other
and hopefully can provide to our hosting friends to better this wonderful
community. <br />
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<![endif]-->Anonymoushttp://www.blogger.com/profile/17124247892171553240noreply@blogger.com0tag:blogger.com,1999:blog-268497958351050641.post-52101027565371483062017-01-27T09:30:00.001-08:002017-01-27T09:30:10.143-08:00Back in the USAAfter 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. <br />
<br />
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.<br />
<br />
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. :)Anonymoushttp://www.blogger.com/profile/13946476638557049750noreply@blogger.com1tag:blogger.com,1999:blog-268497958351050641.post-25345934095076781162017-01-26T18:58:00.001-08:002017-01-26T20:03:48.891-08:00The Ambulance<div class="MsoNormal">
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I got to take a closer look at the ambulance
today.<span style="mso-spacerun: yes;"> No worries, just an inspection, not a personal usage. </span>It had been out of the compound
for a couple days taking a patient to Dar.<span style="mso-spacerun: yes;">
</span>Godwin, the driver, showed me a few things.<br />
<br />
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First, it has a gurney that locks in place, like any
ambulance should.<span style="mso-spacerun: yes;"> </span>I noticed it was very
secure.<span style="mso-spacerun: yes;"> </span>There is an oxygen tank.<span style="mso-spacerun: yes;"> </span>It has a hook for an IV bag.<span style="mso-spacerun: yes;"> </span><br />
<br />
There are two seats, each bench seating two, and
also the passenger seat.<br />
<br />
<br /></div>
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<br />
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<br />
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.<br />
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He even turned on the light for me!<br />
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Godwin then showed me the powerful engine under the hood.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinfheonrR-u_ey_ccCZLM6EyTIDOX1W1fXYu-dQKpA-O8Io_Iyh-SnzYHMw0KTxW4gf1sfTpJjTIhbC_wQvsYq-5VWn9yMkPgeel0SZc8znlj1-qEj8V5botQkPGod_XNZNeQVKXBSKduu/s1600/Photo+Jan+26%252C+11+16+59+AM.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinfheonrR-u_ey_ccCZLM6EyTIDOX1W1fXYu-dQKpA-O8Io_Iyh-SnzYHMw0KTxW4gf1sfTpJjTIhbC_wQvsYq-5VWn9yMkPgeel0SZc8znlj1-qEj8V5botQkPGod_XNZNeQVKXBSKduu/s200/Photo+Jan+26%252C+11+16+59+AM.jpg" width="200" /></a>“Very
powerful,” he said.<span style="mso-spacerun: yes;"> </span>The engine runs
smoothly at highway speeds.<span style="mso-spacerun: yes;"> </span>It is
obviously a pleasure to drive.<br />
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"And new," meaning reliable!</div>
Kenhttp://www.blogger.com/profile/08062952252731045537noreply@blogger.com0tag:blogger.com,1999:blog-268497958351050641.post-3766652570654273242017-01-26T12:12:00.000-08:002017-01-27T02:06:44.999-08:00Ilula Orphan Programso 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).<br />
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Anonymoushttp://www.blogger.com/profile/03179780343295096579noreply@blogger.com1tag:blogger.com,1999:blog-268497958351050641.post-4977213904636164562017-01-26T09:38:00.000-08:002017-01-27T02:08:56.358-08:00 Last Day of Safari 1/24/2016<br />
<br />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. <br />
<br />
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. <br />
<br />
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. <br />
<br />
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. <br />
<br />
P.S. Due to internet problems submitting this late entry!!Anonymoushttp://www.blogger.com/profile/14135511302403358047noreply@blogger.com0tag:blogger.com,1999:blog-268497958351050641.post-37626151736686584072017-01-25T01:55:00.000-08:002017-01-26T01:57:04.614-08:00Kising'a Village Funeral<div dir="ltr" style="text-align: left;" trbidi="on">
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.<br />
<br />
Our blog url is <a href="http://danandsueintz.blogspot.com/">http://danandsueintz.blogspot.com/</a><br />
Here is an entry from our visit to the Ilula Nursing School which might be of interest to this group.<br />
<a href="http://danandsueintz.blogspot.com/2016/06/ilula-nursing-school.html">Ilula Nursing School</a><br />
<br />
Dan and Sue McIntyre<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
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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.<br />
<br />
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.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXO4XqltzcVTXUnUfEdS2RhiV8cyHruxHuqch4SGAmfGbQ7hD-zrbrORLWcQ16lQGwmNpolnGJXbcMPD0_FkUWCRUD9tCKznZqZUjUK_fPq-Hj3q6-lo4k5apNowIkquv6Kkm1RCFIhTc1/s1600/FullCarToFuneral.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXO4XqltzcVTXUnUfEdS2RhiV8cyHruxHuqch4SGAmfGbQ7hD-zrbrORLWcQ16lQGwmNpolnGJXbcMPD0_FkUWCRUD9tCKznZqZUjUK_fPq-Hj3q6-lo4k5apNowIkquv6Kkm1RCFIhTc1/s400/FullCarToFuneral.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Full car going to Kidumuka</td></tr>
</tbody></table>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhz2Ph_xHKtKsTIlD_lQCoeXR2I1k3OhTbaxrVKXMGY-wpHQ5JSwJRr3MFO3qHIfT0IoFGGWtnCuToTgDYzb-dIj5lwMIXR_DHLzvQtUWz-sPvszDL5S7HOtkkT9Ayaah0VByqQThSs-vz9/s1600/GraveSite.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhz2Ph_xHKtKsTIlD_lQCoeXR2I1k3OhTbaxrVKXMGY-wpHQ5JSwJRr3MFO3qHIfT0IoFGGWtnCuToTgDYzb-dIj5lwMIXR_DHLzvQtUWz-sPvszDL5S7HOtkkT9Ayaah0VByqQThSs-vz9/s400/GraveSite.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Graveside</td></tr>
</tbody></table>
<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3OqlJhQdoBSfdj_V7DWfRQXxNA0OSi_Iz-RCRc6CeTagq70a7-cytv1c0WeQqhvaJ_3sUqk5wCRKbZ4cr4TZO4zfum2CFdIgSRBpIZIhdX7CuwJhvbrqye5zS2kTFR8RYC6rueHHChQEi/s1600/LeavingGraveSite.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3OqlJhQdoBSfdj_V7DWfRQXxNA0OSi_Iz-RCRc6CeTagq70a7-cytv1c0WeQqhvaJ_3sUqk5wCRKbZ4cr4TZO4zfum2CFdIgSRBpIZIhdX7CuwJhvbrqye5zS2kTFR8RYC6rueHHChQEi/s400/LeavingGraveSite.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Returning after the service</td></tr>
</tbody></table>
<br /></div>
Danhttp://www.blogger.com/profile/16659689120249482765noreply@blogger.com0tag:blogger.com,1999:blog-268497958351050641.post-56936599319828943702017-01-24T10:18:00.000-08:002017-01-24T10:18:01.779-08:002017 Ilula Minnesota Healthcare ConferenceAs 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.<br />
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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.<br />
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Our conference is based on 5 principles:<br />
<br />
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.<br />
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.<br />
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.<br />
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.<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
Overall the conference was a great chance to learn together, build relationships, and plan together to improve healthcare in Tanzania.<br />
<br />
<br />John Kvasnickahttp://www.blogger.com/profile/09002704530746518664noreply@blogger.com0tag:blogger.com,1999:blog-268497958351050641.post-82177485916592227892017-01-23T11:20:00.000-08:002017-01-23T11:20:31.665-08:00Tungamalenga and Ruaha National ParkHello friends of Ilula!<br />
<br />
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.<br />
<br />
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.<br />
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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.<br />
<br />
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.<br />
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Tomorrow morning we will have a bush lunch and leave the park to return to Ilula. Anonymoushttp://www.blogger.com/profile/03179780343295096579noreply@blogger.com1tag:blogger.com,1999:blog-268497958351050641.post-50439639435905863172017-01-19T11:22:00.000-08:002017-01-19T11:22:13.059-08:00The Fourth Annual Ilula-Minnesota Healthcare Conference, Day 1
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It has been a bit of a whirlwind
over the past few days and the new group is a little behind on blog
entries.<span style="mso-spacerun: yes;"> </span>So I will minimally try to
bring up the slack.
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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.<span style="mso-spacerun: yes;">
</span>I wasn’t long until the Ilula crew arrived, however and dug in to
registration and set up.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>Oh, that new projector is nice!<span style="mso-spacerun: yes;"> </span></div>
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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.<span style="mso-spacerun: yes;"> </span>(There was
applause for that!)<span style="mso-spacerun: yes;"> </span>That made access to
the info much easier and the drives have lots more room for storage.</div>
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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.<span style="mso-spacerun: yes;"> </span>This is an apt description of the hospital
staffs at the conference, clinicians, nurses, pharmacists, administrators,
nursing school principals and others.<span style="mso-spacerun: yes;">
</span>Each and every one of the presentations was excellent!<span style="mso-spacerun: yes;"> </span>And more to come tomorrow.<span style="mso-spacerun: yes;"> </span>We were honored to have a guest speaker, Dr.
Jose Debes who capped off the day.<span style="mso-spacerun: yes;"> </span>All
the talks were excellent and Louise Myers gave an outstanding keynote.<span style="mso-spacerun: yes;"> </span>The other speakers for today and tomorrow are
listed to the right, since they are also the blog authors and conference
faculty.</div>
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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.<span style="mso-spacerun: yes;">
</span>The entire audience loved it!</div>
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There are photos to post too, but
that will wait a day or so!</div>
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<div class="MsoNormal" style="line-height: 115%;">
Ken</div>
Kenhttp://www.blogger.com/profile/08062952252731045537noreply@blogger.com0tag:blogger.com,1999:blog-268497958351050641.post-83556876051700941702017-01-14T20:46:00.001-08:002017-01-18T09:20:28.629-08:00Saturday in IlulaAfter 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.<br />
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.<br />
Louise Myers<br />
<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-268497958351050641.post-91140479514643480642017-01-13T11:55:00.000-08:002017-01-13T13:05:25.481-08:00A Visit to Iringa and all things IlulaAnother 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. <br />
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. <br />
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! <br />
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. <br />
Love Iringa. Love Tanzania. Love the students and our wonderful group of learners and cultural experimenters! Jill Stryhttp://www.blogger.com/profile/15396807442570936564noreply@blogger.com1tag:blogger.com,1999:blog-268497958351050641.post-11128748402454468232017-01-12T10:41:00.002-08:002017-01-12T10:42:02.571-08:00It’s a revolution that brought singing to us!<div class="MsoNormal">
<br />
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3UYJtdVI4uw0j0bWUh1WlzMhqW94Ljve6Qt04SKxNewfiAp33guCyqKPnKPXtKQOqnrajdoS8UdXa2NZEQaJLEa-9Nff6HdKTTlHE9C333BzFr7BiAT8eJV6FGS_pfQN1ZDdk2CTrFdWr/s1600/IMG_4053+%25282%2529.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3UYJtdVI4uw0j0bWUh1WlzMhqW94Ljve6Qt04SKxNewfiAp33guCyqKPnKPXtKQOqnrajdoS8UdXa2NZEQaJLEa-9Nff6HdKTTlHE9C333BzFr7BiAT8eJV6FGS_pfQN1ZDdk2CTrFdWr/s320/IMG_4053+%25282%2529.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Some of the visiting nursing students</td></tr>
</tbody></table>
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. <o:p></o:p></div>
<div class="MsoNormal">
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjH1n-bo1PeIa1WmKidKLttWB920vczix7rYGE5nwQIIQdDsm9wUhIQV2pLR_T0B-8YEReCB9PHf6vaFUdvQhzQ3BEuUCYdpnxFxvKkDkQL34KnpO18n2Ims-Hlxc3FjM-eUbT-NXKV6zuG/s1600/IMG_4054+%25281%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjH1n-bo1PeIa1WmKidKLttWB920vczix7rYGE5nwQIIQdDsm9wUhIQV2pLR_T0B-8YEReCB9PHf6vaFUdvQhzQ3BEuUCYdpnxFxvKkDkQL34KnpO18n2Ims-Hlxc3FjM-eUbT-NXKV6zuG/s1600/IMG_4054+%25281%2529.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Our circle of sharing</td></tr>
</tbody></table>
<br /></div>
<div class="MsoNormal">
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? <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhp_3Val3RT-m782nuKd4JWVnr8nA5G_mXeH-zm6KVCMAXPDaZ_y2zs9unRmfm0ZgP2BgE2hpJQwMXTeSNZEhzbf0OxPTgHz5Lt1xFOcEc-gwwDXhe_cO3whmWDFmfbgfxbLoMA-wh-odrz/s1600/IMG_4056+%25282%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhp_3Val3RT-m782nuKd4JWVnr8nA5G_mXeH-zm6KVCMAXPDaZ_y2zs9unRmfm0ZgP2BgE2hpJQwMXTeSNZEhzbf0OxPTgHz5Lt1xFOcEc-gwwDXhe_cO3whmWDFmfbgfxbLoMA-wh-odrz/s320/IMG_4056+%25282%2529.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Gustavus students singing for us! Lovely</td></tr>
</tbody></table>
<br />
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. <o:p></o:p></div>
<div class="MsoNormal">
We then received a grand tour of the nursing school and took
a picture as shown below.<br />
<o:p></o:p></div>
<div class="MsoNormal">
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhO9EUEkd5wff7IFK6NuEWbMwlFLfQJcaQsIiQiqPXQYiH2ZUQUO5m2yFSMW-wbei10pQ-u_lA9A-oybVj5dMUZwM0GZ_349hC4kT1ZVa3FkxOVz1ygVpTzBZhxUmZbAf17Z7p7TgvrUOfM/s1600/IMG_4057+%25282%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhO9EUEkd5wff7IFK6NuEWbMwlFLfQJcaQsIiQiqPXQYiH2ZUQUO5m2yFSMW-wbei10pQ-u_lA9A-oybVj5dMUZwM0GZ_349hC4kT1ZVa3FkxOVz1ygVpTzBZhxUmZbAf17Z7p7TgvrUOfM/s320/IMG_4057+%25282%2529.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Gustavus students in the Nursing school</td></tr>
</tbody></table>
We said our goodbyes to the Gustavus team as they continued on
their amazing exploration and singing J-term global experience in Tanzania. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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. <o:p></o:p></div>
<div class="MsoNormal">
<u>Side note:</u> 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. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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. <o:p></o:p></div>
<div class="MsoNormal">
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhN-nDwwc70MLgavpZpakHn0VDOC3R8mNUR90ggA69ENAI4hclErjHu2en2rfXhlm-mEW9Ci28SgESr4xHUCmXUZtkraJdk8THtuB1achv8rf7atDPxMVOQHQ6A6k7QOIdQkCDkn6WI4Mrf/s1600/IMG_4061+%25282%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="69" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhN-nDwwc70MLgavpZpakHn0VDOC3R8mNUR90ggA69ENAI4hclErjHu2en2rfXhlm-mEW9Ci28SgESr4xHUCmXUZtkraJdk8THtuB1achv8rf7atDPxMVOQHQ6A6k7QOIdQkCDkn6WI4Mrf/s320/IMG_4061+%25282%2529.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Amazzzzzing views!!</td></tr>
</tbody></table>
<br /></div>
<div class="MsoNormal">
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.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmrZ6taCW5CL6VAH8IMo1AXN1TsCOq2RtsbrD0Svq79LNfC5yR81myDRs6IbjJoc4KFMh-JygOE1ToyOTDIiWmXArZQkCiiurpajESYIrV6p6YEmKDYS5MmCgcNpbYyzE3ROQWUNpt9qX6/s1600/IMG_4062+%25282%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmrZ6taCW5CL6VAH8IMo1AXN1TsCOq2RtsbrD0Svq79LNfC5yR81myDRs6IbjJoc4KFMh-JygOE1ToyOTDIiWmXArZQkCiiurpajESYIrV6p6YEmKDYS5MmCgcNpbYyzE3ROQWUNpt9qX6/s320/IMG_4062+%25282%2529.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Some members of the team at the local pub enjoying the lovely weather</td></tr>
</tbody></table>
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. <br />
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Kwaheri!<o:p></o:p></div>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Salutation"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Date"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Block Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Hyperlink"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="FollowedHyperlink"/>
<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Document Map"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Bottom of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation subject"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Contemporary"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Professional"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Balloon Text"/>
<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Theme"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 9"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 6"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="46" Name="List Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
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Good bye for now.<o:p></o:p></div>
Prosperityhttp://www.blogger.com/profile/18001354826514148198noreply@blogger.com1tag:blogger.com,1999:blog-268497958351050641.post-48049497259516464782017-01-11T13:58:00.000-08:002017-01-11T13:58:40.008-08:00Out of Africa ViewPost of michael madalon who is mostly case insensitive. 08jan17/sunday/ilula, tz/ilula hospital area<br />
<br />
The rosy-fingered dawn begins to massage the retina shortly before 0600 at this time of year....even earlier for a resident rooster (so it goes for brief poetic license with an apology to virgil)<br />
Our group of nine has a classic "out of africa" view from the veranda at faculty/student housing (ed. note: the blog background is the view)....prosperity, margaret, lauren, and lisa jogged the 2 mile path to the valley area...breakfast from our cook, anna, was welcomed and included hard boiled eggs (white yolk), fritters and cakes, bananas, and of course, coffee (instant) or tea and this gets our day started well....our housekeeping person is jennifer....a discussion over breakfast included general blog info, assignments, and downloading photos<br />
<br />
At 1000 we were welcomed by mr. kikoti, the hospital administrator, to the lutheran church service and this event turned out to be the highlight of the day....the building held an estimated 150-200 members and is L-shaped....a large share of the service was group singing, often with a typical african rhythm (think ladysmith black mombazo) as well as some dancing in place....the lady with the red dress and her co-singers with guitar accompaniment as well as a young girl vocal duet were particularly good....one of the music groups had a cd of their work for sale after the service....we scarcely understood a word of the pastor's message but his delivery was earnest and expressive....speaking for our group we were impressed with the upbeat and joyous music as well as the smiling faces of the performers and left the church at 1230 in an uplifted mood...the ensuing thunderstorm was heavy and easily filled a 40 gallon container with roof and gutter water in less than one hour (which is the preferred liquid for our female hair washing, i understand)....lunch was served promptly after the church service and during the storm and included rice, beans, a tomato sauce, and french fries (a familiar culinary theme)<br />
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At 1300 (1 pm) our swahili language instructor, Fatuma, challenged us with her "immersive" style for <br />
learning a language....in another life she would make an effective drill instructor....it is clear that this author needs more practice....when our 3 hour lesson ended, we felt that another lesson would be helpful<br />
<br />
Before our evening meal Randy took us on a 1 mile walk and tour around the hospital campus....on the return portion we chanced to pass dr. Saga's home....he invited us in for sodas, peanuts, and conversation (we learned of his early role in establishing the ilula hospital as well as his recovery from a major motor vehicle-doctor as pedestrian accident over 1 year ago)....we also visited his pharmacy near his house<br />
<br />
Our post walk dinner included fried rice, a red sauce, spaghetti pasta, cauliflower/peanut sauce, a meat dish as well as beer, water, and sofa for drinks....this was followed by a game of swahili word-guessing with a smart phone/timer and the word displayed placed at the guesser's forehead while the group offered the english clue....<br />
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The day was a full one....however we have again learned that americans have the watch, but the tanzanians have the time....also one could note that time flies like an arrow, but fruit flies like a ndizi, especially in ilula.Randy Hurleyhttp://www.blogger.com/profile/14618956667051288045noreply@blogger.com0tag:blogger.com,1999:blog-268497958351050641.post-6674521069878759122017-01-11T10:22:00.001-08:002017-01-11T20:48:11.198-08:001/11/16 - We are the same on the insideToday was another day of working on the wards around the hospital and enjoying learning from each other from both clinical and personal experiences. The common theme that I seem to notice, is that we are all pretty similar. It might be that I have a bias because I tend to look for the things that make us the same rather than what makes us different, but today was full of examples.<div><br></div><div>We have started as a morning routine, those that wish have been going down into the valley for a run or walk to start the day as the sun is coming up at 6 am. It is fairly easy to be awake and alert (and to fall asleep by 8:00 if you don't keep busy) when the sun rises and sets at 6:30 AM and 6:30 PM. Today we decided to take it easy and walk since most of us didn't feel as well rested thanks to the roosters and a couple of really aggressive dogs last night. It was amazing to enjoy the scenery of mountains all around, the sun shiny through the clouds, and a thick fog drifting in the distant valley. Since w have arrived, there has been rain every day which has made the gardens grow and turns the entire valley from brown and gold to green lush growth.</div><div><br></div><div>We split off into our respective groups, with one going to the outpatient HIV clinic, another to inpatient rounds, and a small group to hospice rounds, visiting people in their homes. It was really great to hear the stories of the team doing hospice as they had a chance to see the places that people live and feel the real appreciation for the work that those who have come before us have started and we are privileged to be a part of carrying on. It seems that these patients, with chronic illnesses with little hope of ending their suffering with complete healing, just needed to feel that people remember them by coming to visit and bringing very small gifts such as clean towels, Vaseline, soap and personal care items. No matter if you are suffering through illness at the fanciest care facility back home or in a mud hut in Tanzania, you just need to find comfort in knowing you <span style="font-family: 'Helvetica Neue Light', HelveticaNeue-Light, helvetica, arial, sans-serif;">are not alone.</span></div><div><br></div><div>My experience today was on the equivalent of a maternity care ward with managing patients who are pregnant and may have some complications, those that are in labor, and those that are getting ready to go home after their delivery. Because of some complications in labor, we decided that two women needed cesarean sections. No matter if you are white, black, yellow, or some other color on the outside, when the scalpel comes out, we are the same on the inside. Cutting through layers of different tissues, the end result is a crying infant, ready to face a whole new world with the help of its mother and family. Not all stories are happy endings, though. Yesterday, there was a baby who did not survive due to a prolonged labor and today the mom had to go home. She was discharged with a group of women from the day before. The rest of the moms and her lined up at the nurses station waiting for their papers. This women waited with tears streaming down her face as she responded to the nurse to explain her baby had died, with the nurse softly patting her shoulder saying, "pole sana", I am very sorry. I wished I had the ability to communicate to her that she had suffered a great loss and she will be sad - this was supposed to be the day after her first baby was born and instead she would be taking a tiny body home for burial. Even in English, I have no words. I know many patients and friends that have suffered the loss of a baby and even in a luxurious birthing suite somewhere in Minnesota, the grief is unbearable and I have no words that could take it away. Again, we are all the same on the inside.</div><div><br></div><div>Finally, with no graceful or smooth transition, I will talk about the happy ending to our night. We decided to go to the local watering hole which used to be called The Peace Garden, but has changed many times over the years but is where the team always goes to grab a drink. We made a short walk and just barely got in before the start of a tremendous downpour. We grabbed our drinks and sat to listen to rain beating on the tin roof. One of the workers had brought her baby with and we marveled at how adorable she was. The mother smiled and untied the baby off her back and gave her to us to hold. All of us smiled and laughed as the little girl examined our faces, glasses, jewelry and clothing with small giggles and smiles. As we were marveling, one group member said how wonderful it is that babies are the same wherever you go - "curious and getting to know <span style="font-family: 'Helvetica Neue Light', HelveticaNeue-Light, helvetica, arial, sans-serif;">the world", and "they are all cute and happy.". Well said, and fitting for the thoughts that had already been in my head.</span></div><div><br></div><div><br></div>Margaret Perkohttp://www.blogger.com/profile/09647253489018052098noreply@blogger.com0tag:blogger.com,1999:blog-268497958351050641.post-82158707875118966812017-01-10T07:18:00.001-08:002017-01-10T07:18:25.323-08:00Life in TanzaniaAnother interesting day in Ilula. Lisa Michael and I went to a well baby clinic outsidside of town. Children wedge all charming and dressed in their Sunday best. Actually two fathers came in with their kids though mom was outside. She would drape the child on her back wrap the child in a shall hope on the back of the motorcycle and off they would go on the motorcycle. By the way accidents are the second most reason to go to the hospital after malaria. All the 60 or so children looked healthy though you wonder the unhealthy ones don't come because of neglect. <br />
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I saw a case of Ramsey Hunt Syndrome today that I may not have seen in my 40 years of practice. This syndrome is facial nerve paralysysis associated with herpes zoster infection. It had occurred in unfortunately has AIDS and thus are reluctant to treat her with steroids. Apparently it is not uncommon here. This case was one of a number over which a lively dioscussion occurred after clinics. Randy is a great teacher and very enthusiastic about the program here.<br />
<br />
Monsoon season has started here over the past three days with a vengeance. Must rain inches an hour. Subsistence farming is common here and they are out hoeing their small fields by hand. Actually where the well baby clinic is also is a storage shed for fertilizer and seeds. Despite it being in the tropics it's cool tonight probably because of the rain. Jill and I served red wine and cheese for appetizers tonight and everyone is in a good mood. So long from Tanzania.Randy Hurleyhttp://www.blogger.com/profile/14618956667051288045noreply@blogger.com0tag:blogger.com,1999:blog-268497958351050641.post-63624059835827070462017-01-09T10:42:00.007-08:002017-01-18T09:09:30.651-08:00First Day on the WardsThe day began with Michael, Margaret, Lauren, Prosperity, and myself going for another run into the valley. We ran for about a mile before deciding to turn around due to the mist turning into heavy rain. We got back just before the downpour and ate a delicious breakfast (as per usual) before starting our first day in the wards. Louise had an early start as she met with the healthcare administrator and we all met for a brief church service at 8am followed by a security report, reports of the activities from the night, and we introduced ourselves to the nurses, pharmacists, dentist, doctors, students, and other staff who were in attendance. Jill and Michael were working in CTC (Care and Treatment Center) while Margaret and Prosperity had their work cut out for them in reproductive health and labor and delivery where they observed a baby being born. It wasn't anything new for Margaret who is a pro, but this was Prosperity's first experience with a vaginal delivery and she made it through without passing out!<br />
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Randy, Lauren, John, and I did inpatient rounds and boy, did I learn a lot in a short period of time! We saw a total of 29 patients in about 4.5 hours alongside the doctor, lead nurse, and student nurses. We practiced our Swahili along the way and the student nurses really tried to help us. They were so eager to learn which was incredibly inspiring. Everyone was extremely patient with us and I certainly have enough topics to review tonight before I go to bed. I will say, however, that one highlight from the day was listening to a gentleman who survived a crocodile attack after going to the river to get some water. The crocodile clamped onto the man's face, but he was able to escape with only two "minor" bite marks to the left side of his face. He had a wonderful sense of humor, especially when people were giving him a difficult time, telling him that the crocodile must've been pretty small.<br />
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In the afternoon we went over to Iringa to meet the engineering students from the University of Minnesota who are being taught by Jill's husband, Paul. Their projects were fascinating and it was great to see how engineering projects are so connected to public health and medicine. We got back to Ilula a bit late, but had a nice debrief on the bus and are ready to see what tomorrow has in store for us! Usiku mwema!Anonymoushttp://www.blogger.com/profile/13946476638557049750noreply@blogger.com2tag:blogger.com,1999:blog-268497958351050641.post-38875115442607449202017-01-07T22:39:00.002-08:002017-01-08T13:13:03.370-08:00Shida Kidogo KidogoSaturday Jan 7th started out perspirous eating breakfast at Wista's Chalet at 6 AM in anticipation of the long bus ride to Ilula. We had an uneventful morning start and ride thru Morogoro then Mikumi National Park. From the road we saw zebras, giraffe, impala and a large herd of cape buffalo. We arrived at our lunch stop, Tan-Swiss, at 1:30 PM and sat down for lunch. Our bus driver, Abdulla, however, became preoccupied with issues related to the bus. We have had Abdulla as a driver before: an always-smiling man who speaks very little English. The bus would not start; there was a problem with the fuel intake valve. "Shida?" I asked--Kiswahili for problem. "Shida kidogo, kidogo" he replied--small, small, problem. A fuel valve had gone bad and Abdulla had to call a fundi (a repair man) to come and fix it. We sat in the shade and John lounged by the pool while the bus got fixed. We took off 2 hours later and arrived at Ilula to a welcome by Dr Saga, Kikoti and Anna, our cook. We have a great group this year with some diverse backgrounds; We are all looking forward to the upcoming day with plans for a Swahili lesson Sunday afternoon.<br />
<br />
RandyRandy Hurleyhttp://www.blogger.com/profile/14618956667051288045noreply@blogger.com1