Out of Africa View

Post of michael madalon who is mostly case insensitive.         08jan17/sunday/ilula, tz/ilula hospital area

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)
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

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)

At 1300 (1 pm) our swahili language instructor, Fatuma, challenged us with her "immersive" style for  
 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

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

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....

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.

1/11/16 - We are the same on the inside

Today 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.

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.

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 are not alone.

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.

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 the world", and "they are all cute and happy.". Well said, and fitting for the thoughts that had already been in my head.

Life in Tanzania

Another 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.

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.

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.

First Day on the Wards

The 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!

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.

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!

Shida Kidogo Kidogo

Saturday 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.

Randy

A Day in Dar and the Fish Market Adventure

Today was above all else, an adventure! After getting in quite late last evening, approximately midnight, we made our way to our B&B, Wistas and tried to rest as much as possible for the following day. We all decided it best to start the next day a little later due to all the traveling. The next day, after much needed breakfast and kahawa, our group of now 9 (Louise and Margaret met us in Amsterdam and Prosperity at Wistas, decided to take a stroll to the nearby mall, Mlinani City Mall. This air conditioned beauty felt wonderful after our short, but hot, walk. We explored a little there and got the phones in tip top shape. We then decided to take a trip to the fish market where a very friendly man took it upon himself to be our tour guide. We got a real experience seeing some fish that I had never seen before, in all sorts of shapes, sizes and colors. We learned today from our tour guide that pweza means "octopus" (which were plentiful) and "samaki" means fish. Randy thought with such a wonderful experience with the tour of the fish market that we should have lunch there as well. The tour guide offered us fresh fish, octopus, lobster, but the group decided fresh shrimp would be best. So, we asked a local cook to freshly prepare these little guys for us- and man I didn't realize what a process it was! As we waited a few of us decided to grab a spot and also get a couple side dishes. Prosperity recommended the chips mayai, which was basically just fries and eggs - but was absolutely scrumptious! So, with all the food bought and prepared, we had a light lunch at the fish market. After leaving, we made a quick pit stop at Cocoa Beach and had a cold beverage while sitting on the shore. Lastly, to end the night, a little dinner (and cribbage for some), then off to bed.  Overall, the day was as I said before, above all, an adventure. To be in the center of the culture and really become immersed was something I will not forget. To see the bartering and selling of fish, and how much of a get together it was, it was very interesting. I forgot since the last time I went how much a single group can attract so much attention. It is both a gift and a curse. Tomorrow will be largely filled with travel, so it was wonderful to take a day and explore. And the food wasn't half bad either!

Lobster form the Fish Market in Dar Es Salaam

Our honorary tour guide and one of the biggest fish I've seen in person! 

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We Are Off!

On a very cold Minnesota day we are all eagerly anticipating our flight to warm and sunny Dar!  Our early group is 6 of us:  Lauren Turner, Lisa Huset, Randy Hurley, Mike Madalon, John Zurek and Jill Strykowski.  Our flight is on time and we are all reading a great article about Medical Emergencies on flights to prepare ourselves.  We will meet two additional members of our party in Amsterdam and  our second Pharmacy student has arrived from Nigeria to Dar already and is waiting for us at Wista's.

We will be in Dar for two days which will make the bus ride west to Ilula easier to adjust to from a jet lag point of view.  Our goals for Dar are to visit the US Embassay, and Muhimbili University.  We may take the opportunity to take the team to Slipway as well- the view at sunset is gorgeous.  Randy has the fish market in mind as well - all part of the experience!

Lauren, Prosperity and I hope to undertake development of a tool for future students.  The tool may be common infectious diseases/Tanzanian treatments and a compare/contrast to US treatments.  Looking forward to the joy of learning and working together!   Such a pleasure to participate in this adventure and help folks assimilate, explore and work "shoulder to shoulder".  We are excited and eagerly await this journey on this first day!