Zanzibar

SO i am skipping over last weekends excursion into Masailand and will save that for a Sunday posting. I hopped on the Dar Express for Dar es Salam yesterday morning at 6 am! I caught the last ferry to Zanzibar and am currently typing at an internet cafe (I have 11:30:00 left to write before my money runs out...). It is beautiful here, and the kiswahili is a bit different but I am getting along fine. I have done well in becoming conversant! I have luckily avoided the mtali (tourist) spots. I made it to the darahani market with fresh fruit, veggies, spices!, hanging meat and a fish market. There was one salt water fish being cut up on the ground longer than me, quite amazing. I then hit up the winding markets east of the stone town tourist traps. Many Indian, Arabian and African shops. Luckily (and unluckily with the heat) I wore pants, so was able to go into a local mosque before noon worship. I also walked with a local through a ship building yard. The ships have not changed in hundreds of years and really quite impressive. Finally took a break from the heat here. I hope to find some old men playing Bao this afternoon- would like to learn first hand this very old game. I played it once in Ghana and it was a lot of fun. Pardon any misspellings but with little time, a short stool and Araibic keyboard this is difficult. I hope to post some pics when I return.

Only 3 days until I return home, and so much to see! Hope all is well with family and friends, can't wait to see you all- especially LAURA, CHARLIE & ELLIE!!!!!!!!!!!!!!!!!!!

Tutaonana,
Eric

Out with Captain Fresh Legs

Another national holiday yesterday!















So Bryant and I decided it would be good to mountain bike daily. Sounded good at first. Then we invited Mat Bailey with us (Captain Fresh Legs). We had been going up hills for 4 days and invited this crazy Aussie for another spin. Love biking with him, for sure, but our reserves were low this time. And he hadn't biked in several days.

Mbutwai and Kimane stopped in this am to finalize plans for our trip to their farm- we're leaving Friday afternoon and returning Sunday. It should be awesome.

We ate some toast and then started working on public health. About 1 PM Bailey texts us about a ride. We tune up Bryant's bike, inflate the tires, knock off the mud and go. We are usually gone about 2-3 hrs. Today we went very very very far up.

After about 2 hours we decided to take a very steep pass cutting through the side of a mountain. This went up for about an hour. The incline was about 60 degrees and a lot of bike carrying. We found a duka shop in the small "village" of Oloigeruno for some expensive warm coke and slammed them down. None of us expected such a long day and we didn't have much water. The locals borrowed my bike and we talked with the kids. Then we heard about a waterfall even further up. We hit a very nice grove of evergreen trees that reminded us of Minnesota. Far back into this we hit another slope that ended our climb. The waterfall was very far away and nowhere near us!

We replaced Bryant's back tire and headed down the mountain. Very steep and on either side of slick mud paths are nettles that will cut you if you simply look at them. Bryant took a header over the handlebars into them, and we found an easier slope. Throughout there are bridges of rough cut trees over streams/ravines/etc. Half way back through a small group of Bomas we met Michael, who insisted we come to his small home. It was about 10x20 ft, split evenly into 2 rooms. Entering the door, the first room was empty but very clean. His bedroom barely fit a twin bed and small table (just large enough for a small briefcase). He showed us numerous pictures of random people and his text books for education. He then lead us out of the valley. But as we left he chose paths that went up rather than down and so we departed with the last of our energy.

Overall we saw many spectacular views, met many children asking for money, water, our bikes and are completely exhausted. We just ate an impressive meal of steaks and pasta, probably more than either of us has eaten since arriving.

I am excited to be here, with so many experiences packing the day. But I also can't wait to get home, start residency and especially see my family! Laura and I are looking for places to live and it is an exciting prospect to have some comforts of home and space to stretch out.

Mtasinzia mzuri,
Eric

Easter Ride

Easter Sunrise service was at the Simonson's this morning. They have been working in the NE region of Tanzania for many years, and built a home here in the early 1970's. They have a beautiful large home fashioned after the traditional Masai boma- so it is a round and very open building with an inner circle within the outer wall. An amazing gathering area within with a great loft overhead for sitting. One amazing thing is they have no bars on their windows. Everywhere there are bars, covering all shop enterances, every window, every doorway. It is a necessity for virtually everyone here. They have earned the protection of no bars though, by many years of service. We had cakes and some fruit after the service and I returned down the road with Sarah Wallis.

Later that day... Bryant and I watched the documentary "Darfur Diaries", a documentary I found while reading What is the What (by Dave Eggers). Informative but depressing/infuriating!

Then we jumped on our bikes and got lost up the mountain. There was a lot more mud, a lot more off-roading, and many wonderful sites. I fell off my bike more times today than in +10 years of biking as a commuter. Pausing along one trail next to a stream to take in "I am in Africa. I am mountain biking down a beautiful stream." Amazing. Many times we ride through small villages and are chased by the local kids. We caught a bit on tape yesterday. Of note, I know I don't tan (honest!), but I didn't know I was whiter than white. Can you differentiate my t-shirt from my skin? Cause I can't.

Last evening we made our way up Il Buro to Sarah's home for a bbq. Jose (Argentinian MD working in Mn) controlled the grill and did an awesome job. A great way to end the day- chating, beer and a fire.

Mbutwai & Kimane stopped by today (Monday). We will be going to their place Friday afternoon, returning Sunday. I will move on to Mto wa Mbo (Misquito River) to work with Dr. Friberg hopefully for a week. Things are winding down here it seems!


Eric

A little bit of everything

Water!
Water has been scarce in Arusha/IlBuro/Ngaramtoni area. The short rain season provided less than expected, and now the long rain season is late in appearing. We have just now entered the rains, and it is quite nice. The dust has settled down, making walks and mountain biking much easier on the eyes and lungs. There are powerful rains for a few hours/minutes and then cooler temps and beautiful sunshine.


On Tuesday Dave & Russ left for home, and simultaneously our water tank was fixed. It has been about 3 weeks with only a slow flow from the kitchen sink. Our routines are fairly standard with water here. First you get a bucket and drain some water from the faucet for a shower. Next you grab some water and heat it on the stove so you don't jump from the cold, and when it boils you add it to your bucket. At the same time you can put your cup under the water filter and in about 10 minutes have enough water to drink. A second bucket is taken back with you to the toilet so you can flush.

This doesn't include the water taken to hand wash all our clothes (thankfully Christina does this for us!), or taken for food. It is pretty amazing how reliant we are on easy water, and how much it is taken for granted until it is almost gone. We are fortunate here, our neighbors do not have easy access to water like we do, so even in our “difficult” situation with water we still do not have to walk down the road a quarter mile and back with a bucket on our head. And we can easily heat our water, compared to gathering firewood. So, overall, we are still blessed at Exempla.

Il'Kidinga
Last night Bryant & I grabbed our bikes and headed back up the mountain. We made our way to Il'Kidinga again and stopped at a shop just outside Kionga for some tepid Cokes. I am standing on one side of a valley, Bryant on the other. In the middle was/is a small stream where mzee (old wisened...) women were washing clothes. A Masai warrior was sitting just below Bryant in this pic grazing his cattle. It was, again, an amazing time to see the countryside and meet locals. The ride is beautiful with Meru always in view and great little streams to ride through. We crossed one in particular several times. The photo of the kids (Watoto) is just as we entered the stream.


Maasae Girls Lutheran Secondary School
Last Sunday I joined Ashley & Sarah in a trip to MGLSS. Ashley founded AfricaAid, which I have included in the blog links and Sarah has joined her here these past few months to help. Their organization funds scholarships to Masai girls secondary education. I was introduced to Jean and Marvin Whalstrom, two missionary teachers from Seatle area who have taught at the school for about 8 years. They are terrific people with large hearts for service.

The school is fashioned similar to the boma structures traditional to Masai. There are several dormitories, classrooms, laboratories and administrative offices. Centrally located is the open air chapel, very beautiful and comfortable. Ashley pointed out the beams holding up the roof, they were apparently from I-94 in Minneapolis! The founders of the school (and Selian!), David/Eunice Simonson, collected them when construction was occurring several years ago. Small world!

From numerous perspectives, educating the women of society is possibly the biggest return on investment that people/institutions/churches/organizations can make. Besides the simple point of sexual equality, it has been proven to improve mortality/morbidity surrounding childbirth, control population expansion (more education = fewer children being born), improve sanitation, improve the education level of the whole family, and a lot more that I won't go into. It makes a lot of sense.


UN Rwanda
The kiwis set up a trip to watch UN International Criminal Tribunal for the Rwanda genocides on Thursday. After quickly rounding at Seliani, Jose and I sped home, changed and made the afternoon session with kiwis and Bryant. The genocide in Rwanda is currently being dealt with by the UN here in Arusha. The numerous trials have occurred for past 8 years, and were supposed to be completed this year.

They have 4 courtrooms which run at various times. If the court is open we can watch, with headphones translating the French court. If the trial goes closed we get up and leave. The public gallery is separated physically by a glass wall. The witness was protected, so there was a curtain hiding his identity. There was a 20 minute closed portion of the trial, which we left, and when we returned we only heard mention of the killings/etc he had witnessed/participated in. Such an interesting process here. The focus on the witness was his participation in guarding a camps entrance, whether a particular civilian who was murdered was in a truck, and what was actually witnessed vs hearsay/conjecture. The details were tedious, the lawyer for the defense horrible, the process slow. But still, amazing to see unfold. In reality, justice is not flashy.


Seliani
I spent about 10 minutes with the OB/GYN team before realizing that there wasn't going to be much work for me. I have jumped back in with the medicine team. There are many frustrations that have been difficult to stand by and watch. Last week there was frustration not due to LACK of adequate meds, but proper administration! We would give detailed instructions on patient care, and find the next day that very little has been followed.


Donations
I am beginning to reach out to the community about the donations we would be distributing. Hoping to balance out between public health & medicine/PT. Right now I am coordinating with a few different organizations, and I hope everyone will be happy with the results!


Tomorrow, Easter, we will be going up to the Simonson's home for sunrise service. It will be nice to visit with many of the "movers and shakers" in the area. Peace to all!

Eric

Life back in Minnesota (Laura and Charlie)

As many of you have probably figured out, Charlie and I decided to head home a month earlier than expected. There were a few reasons for that: 1. The work that I (Laura) could do was limited by the fact that I had a 20 month old running around...loved it, but hard to work with other kids when one very adorable kid is demanding my attention. 2. There wasn't much to do with young kids in Arusha besides a swimming pool and play groups. It was a bit isolating. 3. The security issues were still there...better, but still there. 4. I wanted Eric to have the freedom to go off and travel to villages, treating individuals, if he wanted without worrying about us at home. Those were the main reasons. Another valid and fun reason was that my sister just had a baby and this gave me an opportunity to fly to Fairfax, Virginia to see the little guy. He is precious and it was fun to be able to help her out early on.

It has been busy since we have been back. The first week was spent getting over jetlag and visiting my new nephew. The second week has been getting organized. I am in the midst of trying to find a place to live (my parents have lovingly opened their house up to me and Charlie but I am anxious to find a place to call home again), doing taxes, and making a space for Charlie and I to stay in the basement for a while. It is humbling, frustrating and very nice all at the same time...strange but true.

That's it for now. Hope everyone is doing well AND, I too, want to make a public proclomation that Charlie and I miss Eric. We can't wait to see you!!

Mbutuai stops by

I took Tuesday morning off to work on public health and orient a new internal medicine doc to the area. As I returned home in the morning Mbutuai and his brother Kimane stopped by! We had some chai and discussed Mbutuai looking for new employment. He was not being paid by the landlord when we were with him. They liked having pictures taken, so we can pass them along to their family- but I thought I would include them here as well. I'm sitting with Kimane, Bryant is with Mbutuai. If Byrant and I look crusty it is because the water is still out.

The good news is we worked out to visit their farm/home near the serengeti (~4 hr drive) in a few weekends and I finally got his number. It was good to see them again and I look forward to the day I can speak to them in Swahili- it is a real motivator to learn the language.

The new IM doc (Jose) was here last year for 5 weeks. He is originally from Argentina and I will be working with him this afternoon at the medicine clinic. Tomorrow we will be grilling out: Nitapika njema nyama (I will cook good meat)!

Peace,
Eric

Notes from a dusty rider

Just returned from a fantastic mountain bike ride with Mat and the new med student Dave (from New Zealand). We went up the hill quite a distance near a village called Il'Kidinga, and close to where I have done some home visits with hospice. Then we hit a lot of the streams/paths that I had been eyeing up for the past few weeks. There was a lot of incline/downhills and numerous obstacles- very fun. We passed through a weeks worth of touring the countryside in just a few short hours. Our bikes are not great, Dave and I did our best yesterday to tighten everything up. About half way through the ride Daves pedal crank began to make death threats- sounded like a dying cat. By nightfall it was hardly turning, we poured some water on the housing and sped home with haste. We passed many groups, kids chasing us, families coming out of their bomas to say hello, large church parties along the hillside. And a beautiful sunset. It was a great dusty adventure and I know it is something I will miss on my return home to Mn.

This past week at Selian was somewhat short for me, as Laura left Monday and I was at ALMC for clinic Tuesday. I spent the remainder of my time on the medicine wards. There have been quite a few deaths lately to deal with. I had some frustrations with a very old women who was going into shock. Most of my requests for care seemed to fall on deaf ears. I finally got a non-rebreather mask on her to help her breathing and they all wanted to take it off because patients don't find them comfortable! I unplugged from the team after we left her case, as I found myself teetering between apathy and cynicism over the care being provided. By Thursday I was doing well, but there have been several patients who have passed, and many more coming in for what appears to be paliative care. I have started going in on Saturday mornings now to spend extra time at the hospital. A man came in with a large tumor the size of a cantelope- where is the pre-hospital screening that should catch these things before they are deadly? No where to be found. I think primary care development here would save A LOT of lives. Many many different patients this week: an alcoholic (local Konyagi liquor here), TB meningitis, strokes, sepsis, malaria, AIDS, and many more. I plan to spend a week now with OB/GYN, and go from there. I have recently heard from another doctor that I will travel with in late April out into the rural areas, so I am excited to get out. The 2 hospital pics: one of Selian's low-tech ICU and the other is me with the hospice team.

Exempla house has decided to throw some challenges our way. We have been without water for about one week now. We are all getting fairly rank without access to showers and this warm dusty climate. We have a slow flow from the kitchen sink (cold water only). So we can fill our toilet tanks and take sponge baths. Before church today, Bryant and I went to ALMC early and showered for the first time in a long time, it was very cold! It seems they don't have hot water there yet... But it felt good. There is a fairly significant drought here as well, in contrast to the flooding in the midwest currently. It rains very infrequently and the dust is everywhere. The crops are dying and there doesn't appear to be relief in site. Kilimanjaro appears to be fairing even worse. Today at church they ended with an open mic to talk about what verses helped everyone "get through" the day or rough spots in life. It was great to hear the diversity of text being spoken and find what gives people strength.

Two new roommates came in the night Laura left. They are an ortho surgeon and ortho physicians assistant from Stillwater. They spend a great deal of time at ALMC, but we have spent the evenings going to dinner and getting out of the house. It has been great to see Arusha at night, even if only from a range rover window.


And a public proclomation that I miss my family! I don't like Laura and Charlie being away from me for this long! Charlie said his "goodbyes" to friends made at play group.



The simba (lion) was one of Charlie's toys here and keeps me company at night.





Also, just found out we received a nice amount from St Lukes church (our home church) as a donation! We really appreciate everyones support in our work and we will do our best to find an appropriate use for the greatest good.

Eric

PS- Charlie started eating more veggies his last few days here: cucumbers, carrots and green beans. Well, not eat but chew and spit out. It's a start.

After the Match

A lot has happened over the past week or so, making it difficult to attend to a blog. I have been walking home from Selian a lot this past week, and have noticed I am on my last belt notch now- going to have to start eating more for dinner!


Selian: I have bounced around hospice care and medicine wards again last week. Beginning in March the hospital changed from private Lutheran to a government hospital (with no shift in the Lutheran function). The basic change is that children, pregnant women and the elderly are provided FREE care, with small bills for items such as linens, etc. There has been the anticipated increase in patient load, and this is likely to continue for some time. One disadvantage to the timing of this is that when ALMC (the new Lutheran hospital) opened, they took several of the most qualified team members with them- nursing, clerical, attending doctors. Selian has scrambled to rebuild, but it will take time. The hospice patient I described last week with HIV/Kaposis ended up having pulmonary TB as well. He died last Saturday afternoon, likely from the kaposis and TB disturbing his lung function. It was a very sad time in chapel when I heard about it during morning report. He presented so late in the disease course that there was not much we could do, and he was too sick to transfer to KCMC for the chemotherapy he needed. This past Tuesday I helped orient 2 new students from New Zealand. The pic posted here of Selian is from just outside the chapel- looking in the background you can see Mt Meru!

The Match: There has been a lot of excitement this past week leading up to Thursday evening (we found out at 8 PM). With Laura and Charlie leaving for home on Monday I took Wednesday afternoon through Monday off. Thursday morning we walked into town for some food and also bought a nice bottle of Jameson and Johnnie Walker whiskey to celebrate. They were nice to help calm the nerves during the final hours. We had several people over for dinner- Mat & Jane, David & Julian (new zealand med students), Mark & Linda. Bryant, Laura and I made some chicken masala and lentil indian dishes for dinner. After we found out we were very happy to find out we were going to stay in Minnesota at Regions Hospital in St Paul. Since then I have received several emails from the program welcoming me- very nice to feel wanted!

Public Health: I have lately been working on a project for my public health degree related to malaria. I am hoping that I can use it to complete my MPH degree. Right now I am basically looking through last years lab book and taking noted on all the patients who had malaria slides taken. Were they + or - for malaria, how many slides completed, etc. Then I start looking through their files to see if they were given anti-malarial medications, ever had a real temperature, etc. The reason for all this investigation is because I noticed that malaria was diagnosed here in almost every person, even if there was not a scientific reason for it. The hope would be to eventually create a study that would help them test malaria better or treat more appropriately.

Life: Last night we went to an outdoor bbq and movie night. Sarah hung a sheet in her back yard and we watched "The Gods Must Be Crazy", that is until the power went out at 9... Laura and Charlie left for home last night. We had a very fun morning together, and spent the last few days spending a lot of time together. I am noticing their absence though- not being woke up at 6:45 every morning to "Hi!" from Charlie in the crib right next to us for one thing.

2nd part! Best part!

We found out tonight that Eric matched at Regions in St. Paul. We are very happy and busy thinking about our next "move" as we have everything in storage right now! Thanks for all the support. We will see you all shortly!

The first part of the news!

Eric matched!! Yeah! This is a relief for Eric. I knew he would match...too smart and too good. Anyway, Eric just went to Selian and Charlie and I are kicking the soccer ball in the yard. "Boots" "kick!" "ball!" (that is what Charlie says.)

36 hours until Scramble Day

Monday at noon I will know IF I matched. No real news here, but an excuse to post a video of Charlie again:





Charlie tried waking up Laura with some passion fruit this morning! Didn't work!!







And some pics from the yard, flowers are blooming daily!






















































Hope all is well with everyone, things are going well here. A more detailed update tomorrow evening!!!
Eric

ps- the pics don't do justice to the beauty of this yard...

3 days until match day

So I am a bit anxious to know THAT I matched (March 16, noon) and then WHERE I matched (March 19, noon). I don't usually dwell/wish for tomorrow but this week I actually do. Charlie is babbling away and trying to sing now! Very entertaining, enjoy:





Eric

The way of life in Arusha

The following is a typical day in Tanzania, read on: Last week, I made arrangements with Margaret, the gal that runs Step by Step for the handicapped kids, to come today for the whole morning without Charlie to work with the kids. I arranged the time with Eric so that he could look after Charlie and I was excited. This morning, I sent out my notes on the kids via email to Margaret and then had a taxi pick me up and take me there at 8:30am. I paid him 6000 schillings (about 5 dollars) and he dropped me off at Step by Step. It was closed, locked up, shades drawn. I waited for 30 minutes and finally texted Margaret, "did I get the start time wrong?" No, she replies, "I'm sorry. I forgot to tell you. It is a public holiday" end text. I then text my taxi driver to see if he can pick me up (he gave me the best deal) but to no avail...he is not answering. I walk about 6 blocks until I finally find a taxi. Since it is a public holiday (which I was not informed of), there are very few people working at all today. I find a taxi and they want to charge me 8000 schillings. I say, "no, 7000, and that is my final offer. Otherwise, I will take the dolla dolla," which is a joke because if my goal was to end my life I would take the dolla dolla. He finally agrees on 7000 schillings and I get a ride back to the house.

A little bit about the taxi ride: no seat belts, no shocks, car feels like it is falling apart. As we pass the patrol, the taxi driver half heartedly wraps his seatbelt around him (the only seat belt in the car) without buckling it until we pass and then swings it back to his side. The ride up to Il Boru is very bumpy and a car without shocks feels truly like it is going to fall apart. A few times up the hill I thought to myself, "I'll just walk from here. Pole, pole car..." I get to the gate and am finally home. "Karibu sana" the taxi driver says (you are very welcome) and I come inside. I am frustrated, have just spent about 11 dollars for nothing and did not help anyone today (except maybe the taxi driver). Then, I remind myself, it is just the way of life here...

Now, I am going to play with Charlie and Eric!

Hospice Week

A picture heavy entry here!

There is a lot that has happened over the last week both at Exempla house and the hospital. This week we spent time getting to know our yard. We made mixed fruit juices from passion fruit, guave and mangos. We also cut down our first bunch of green bananas. While looking for avacadoes we also came upon a great little lizard! On Saturday we had a scourge of biting ants march across our yard. I could not get a sufficient picture, but they were a menace. Eventually our gate keeper cleared the ants with kerosene.





































I started walking home from Selian this week as well. The ride is usually quite bumpy, but it is a very nice walk home taking about 1-1.5 hrs. It allows for a lot of time to think. The kids here seem to learn limited English- mainly "give me _____ (money/pencil/your water!)". It's quite rude I have noticed, but enough tourists have visited to make a decent payoff for them to continue. Other locals are much more pleasant to visit with. I was able to chat with some while they tried fixing the brakes on their bicycle today, and was invited to lunch at a local farm. You will often see women carrying something on their heads: water buckets, bags, firewood. And several herders with cows or goats. But the landscape alone would be worth the walk. The weather is pleasant and there is a view of Mt Meru as you go. Right now there is a deep layer of dust in some areas, reaching several inches.



Pole pole, so the saying goes here: slowly, slowly. Last Monday morning was all about slow. I sat through 3 hours on work duty hours in Swahili. I then took 40 minutes for tea as I waited for medicine to start rounding the wards. I stepped into the hospice office but received looks like I was interrupting more than tea time so I went back for more tea. By 1PM we had finally rounded on half the medicine ward.

The cachectic woman I previously mentioned had an ultrasound performed and a diagnosis of either cholangiocarcinoma (gall bladder) or pancreatic cancer. Either way she has been referred to surgery for possible paliative care, and to hospice services. From the perspective of public health it is an interesting case because there does not seem to be adequate pre-hospital care for these communities to catch advanced diseases. People are so secluded by geography that they rarely seek help until problems are too advanced for inconsequential actions.

I enjoy the hospice team home visits because I can get out into the community and am able to use my training well while outside the hospital, which I find fulfilling. There is a new patient that I met last week on a home visit who is now at Selian. Walking up to his home, we were met by several elder Masai women. Getting inside the small doorway it was very dark and difficult to see well. We were squeezed in, sitting around the bed of a 40 yo man. He was lying in bed, telling his story. After he sat up, it became obvious that he was going to need more than hospice could offer. His legs were covered in small Kaposi's sarcoma lesions, they were more swollen than anything I have ever seen, he was fatigued, had a cough and what sounded like a pleural friction rub in the lungs. This all added up to a likely (as yet) undiagnosed case of HIV/AIDS with associated Kaposi's sarcoma. Until he was in the hospital I thought he might have TB, common things being common, but the sarcoma had spread into his lymph nodes causing the leg swelling AND into his lungs. He is now being prepared for chemotherapy which should help decrease the sarcoma and start on ART for HIV. In the picture I am checking inguinal lymph nodes to show the hospice team the exam maneuvers and to determine the extent of the swelling.






While rounding today I diagnosed my first heart block and was able to talk the interns through what it was, what it sounded like and what would be best for the patient. Unfortunately she likely needs a pace maker, and this is not something commonly accomplished in Tanzania...













Today I came home to a very tired Laura who had taken Charlie all over Arusha. He was a ball of energy and all over the yard/house/floor today. He apparently seized the day and throttled it!!!











Laura is enjoying herself and seems very happy these days. She is relishing her last 2 weeks here. Tomorrow she is going to Step by Step while I spend time with Charlie. She is going to help coordinate peds activities, but I will let her tell you all about it tomorrow!

I will add more to this tomorrow, because it is late here!
Eric