Gathering with the Ilula Nursing Students

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

First year students African dance

Photos with rafiki (friends)

Friday in Ilula

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

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

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

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

Back in the USA

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

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

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

The Ambulance

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

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

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

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

He even turned on the light for me!







 Godwin then showed me the powerful engine under the hood.

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



"And new," meaning reliable!

Ilula Orphan Program

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

Last Day of Safari

1/24/2016

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

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

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

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

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

Kising'a Village Funeral

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

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

Dan and Sue McIntyre

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

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

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

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

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

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

Full car going to Kidumuka

Graveside

Returning after the service