Habari! (How is the day?) Nzuri! (The day is good!)

Adding to Laura's safari post, I will insert some pics about the trip. We collected several, and I will try to put together a slide show some time as the landscape and animals were truly amazing to be around. I noticed that once you are out of Arusha the country side opens up a good amount with great expanses of land and large mountain ranges. Masai in their colorful plaid blankets roam the land near their bomas (homes) with their cattle. It is peaceful out there and I will try to get out and see what I can. I hope to visit the settlements with a worker from Selian who performs health assessments once Laura returns to the states.

On safari the lions were amazing, although I did not realize what a brutal life they must lead until I looked through our pictures and saw how banged up they get! We saw a small pride attack a water buffalo, and as they attacked several were trampled and rolled on their backs. The last lion standing gave one last effort by grabbing the buffalo's tail, but in the end it got away. It was great watching them come into the valley and slowly surround the 3 buffalo.

As many of you know, Charlie loves chasing birds. My two favorite of the trip- the superb starling and this white/black/orange variety were at our picnic lunch. I tossed them a crumb since I was still not feeling quite well in the stomach and the starlings went nuts on the other bird! Needless to say, you can see Charlie's response!

Today at Selian I worked with the pediatric team again. We have one patient with a kidney disease (nephrotic syndrome) who we just aren't seeming to help. We are hoping to treat schiztosomiasis, a tropical urinary infection, but the drug is out of stock (surprise!). It is a best guess right now anyway. We are treating the syndrome with the usual steroids, and diuretics to help him lose water weight. It is a waiting game right now but frustrating as we don't seem to be helping him.

During lunch, some of the Swedish medical students rotating at Selian mentioned 2 women in outpatient clinic who had attempted suicide by ingesting pills. The first was a young woman who downed some rat poison (warfarin- an anticoagulant, makes you bleed). The other woman had overdosed on unknown pills and was given activated charcoal to help remove the toxins. Outpatient clinic is run by house officers, who are not trained physicians. For all their good intentions they do not have the training for complicated patients. We left lunch for the outpatient ward with an Australian ICU doctor named Matt (pic at his house in a previous post). The story given was that this woman had been seen by a young boy taking unkown pills, and now she was unresponsive. In the small triage room, this woman was out on a bed. She had a coma scale of 3- as low as you can get. It was frustrating because people like this should not get charcoal as they can aspirate it into their lungs. It was also frustrating because she needed a respirator, cardiac monitoring and appropriate labs. The best she would get were IV fluids and an oropharyngeal tube so she wouldn't choke on her tongue. In spite of this it was good to see where I might be more useful in the future as a trained emergency medicine physician and help Selian improve their ability to care for patients like these.

On the way out of the ward Libby noticed the girl who had taken the rat poison. She was sitting in the waiting area waiting for discharge. It was a good catch by her because the girl needed to be admitted for observation and given a shot of vitamin K to counteract the warfarin!

Tonight we decided to consolidate all the Selian volunteers into the exempla house down the road. The recent break-ins around Il Buro have ruffled some feathers. We quickly packed up our house as the electricity had been shut off and it was getting dark. The place is really nice, although it was hard for us to leave MButuai (our guard). We are going to try and stop by to see him after the move. While we waited to go he brought out a book on Masai and we talked through the pages. We discussed his traditions a bit and he brought out his Rungu (a 1.5 ft heavy wood club with a small ball of metal on the end), which he can use as a weapon. It was pretty awesome.

We ended the night unpacked and tired. I got bit by a large ant while unloading and will try to get a pic of one sometime as they are impressive. It is amazing what you can see on the ground at night with a headlamp. Endless activity amongst the ant hills as hundreds of ants attacked nightcrawlers coming out in the night!

Eric

ps- Charlie is becoming proficient at: habari! and this goes far while walking around Arusha.

Safari/time with family and friends

Okay, family (Whatley family!)...I hear you...I will try to write more often even though 1 week is not that long. Eric is the expert at putting in the pictures and videos so he will do that when he has some spare time.

Things are settling down here. Right before our safari there was some concern about the security in the area so it was a good time to get out of dodge for a little bit until the Jacobson's and towns people were able to clear things up. The Jacobson's have lived here for 30 years and are well known in Il Boro. Mark started the Selian hospital and Linda, his wife, works as a music teacher, social coordinator for all the volunteers coming to Selian and raised their children here. Since coming back from the safari, security has increased and the town leaders have been connecting to make sure the police are cooperating to keep Il Boro safe. Eric and I have also decided to move into the house down the road with other students so we are not alone in one house and the landlords/gate keepers have been notified to be extra vigilent. SO, we are feeling much better now.

Now about the safari! Bryant's girlfriend came to visit this week so we decided to reduce costs and all go together. We started out by driving about 2 hours out of Arusha to a campsite near Lake Manyara. This was no ordinary campsite. The tents were equipped with actual mattresses and had bathrooms with running water and showers. Eric, Charlie and I were offered the guest house for no extra cost...it pays to bring an infant along! The scenery was also amazing. We were on a mountain, surrounded by trees and greenery, the sky was clear and the weather was dry and about 80-85 degrees! We dropped off our bags and headed to Lake Manyara in a Land Rover with a pop up top (incidently, the Land Rover has no seat belts and no car seat, but that is not abnormal in these parts). :) Once in the park, we were almost arms length away many times from baboons, cape buffalo, giraffe, zebras, elephants, many varieties of birds, water buck, impalas and wart hogs. We will post some pictures soon. Back at the campsite, they made us a "western meal" consisting of fried fish, potatoes, and a veggie casserole (Indian style). Charlie, of course, did not eat any of it and feasted on corn flakes and peanut butter bread.

In the morning, we left at 6:30am and drove about 2 hours to Ngorongoro Crater. It was awesome!! We saw 12 lions and a group of lions attempt an attack on a cape buffalo. The perfect scenario, all the action but no kill! We got it on video tape so will try to download it later if possible. We also saw all the animals we saw the day before except elephants and giraffes. The terrain did not accomodate the vegetation needed for giraffes and elephants. There were many, many water buck and baby water buck. Supposedly, the babies are easy kill for lions, cheetahs (we saw 2!) and cape buffalo. We spent all day in the crater, ate lunch by the hippo pool. Hippos are not very interesting. All they seem to do is laze around in the water and only occasionally roll or bring their head out of the water. Their skin is very thin and so they stay in the water and roll in the mud to protect them from the sun.

We spend our last day of the safari at the Terengetti. It didn't have many animals since many had already migrated but we did see some fascinating birds and the scenery was peaceful. Charlie did great! No major tantrums, was interested in the animals and sat on our laps the whole time. I am speeding up this entry because he is now awake and getting very busy. I will write more later...maybe when he takes a nap. :)

ROL

ROL= Rank Order List.

My list has been certified for residencies- meaning that I have put all the programs I interviewed at this winter in order and hit the submit button. Now we wait a month (for March 19) to find out where we match to! One more step complete.

We had our first real power outage here too, a night of candle light and then the power was back up!

And to celebrate, here is a pic of Charlie with chocolate milk and a picture of some cheetahs we recently saw. I know, random right? But it's midnight here...

Eric

A few pics worth 1000 words

We've had quite a day here. I thought I would just add a few pictures that helped us through:

Charlie at playtime today (choose your own caption on this one):














Yesterday, MButuai (our guard) was trying to ask me something and I couldn't put it all together. Today I figured it out- he wanted to get some pics with us and Charlie in his traditional Masai clothes (with his brother, Kimane) as well!










































We are unexpectedly off on safari tomorrow morning through Monday evening! Bryant & his girlfriend Brooke are headed out and we are tagging along to split the costs for all of us. We should have some great pics/stories for you all then.





And every night ends well when Charlie has a shower!










Until Monday, take care and keep us in your thoughts- Eric, Laura & Charlie!

Funny thing happened today...

So, I was reading through my former posts and realized that they all sound a bit depressing. Sorry about that...I feel the tide has changed and life here is actually really nice in many respects. The weather here is beautiful, you can't get better than this...sunny, mid-80s during the day and drops down to 60s at night with a few rain showers here and there. I have also met some wonderful people. I attend a play group for Charlie on Wednesdays and Fridays which has been lovely (I feel like I am talking a bit like a Brit since being here since I am hanging around many of them).

The play group consists of ex-patriotes (mostly Europeans) and many cute little kids. The play group on Wednesday is at a woman's house who is an elementary/pre-school teacher during the days. She has a nice set-up where kids can paint, play in the sand-box, jump on a trampoline, play with toys, explore their surroundings. The play group on Fridays is similar but not as well equiped with all the "goodies" but is definitely good conversation. The play groups have been really nice for Charlie and me...Charlie gets to play with people his own age and I get some adult time and understand more about life in Tanzania (I promise to take pictures next time and post some).

Many of the ex-patriotes are committed to staying 3 plus years working at the international school or due to their husband's job (computers). They are all very realistic about how they feel about living here stating that they have their ups and downs. The upside is that a mom can stay at home and live a relatively comfortable life taking care of the kids, the weather is fantastic, and the people are warm and friendly. The downside is that there really isn't much to do with the kids besides a swimming pool at the Il Boro Lodge and outings like play group. One can feel quite isolated if you don't plan get togethers weekly. The moms all have cars which they say has been a life saver and really helped in getting adjusted and acquainted with their surroundings.

The slower pace is becoming much easier to handle...and I quite like it now. Lazy mornings, playing with Charlie, long walks with Charlie on my back, scheduled lunch and nap times, when Charlie naps I read or take a nap with him. It is quite luxurious. On Tuesday and Friday mornings I go to Step by Step, on Wednesdays and Friday afternoons I have play group, every other Thursday I have bible study. These activities have come to be enough for me to easily settle in and really start enjoying life here. I have met a few regulars on my morning walks with Charlie too! I realized after talking to one man that owns a shop along the road that his main goal was to find a white woman to marry and wanted to know if I knew any of them and if I thought it were possible. Now that was a loaded question! I wasn't quite sure how to answer him without crushing his dream. The thought of an American woman marrying a man that happens to be of the Masai tribe which historically do not treat their women well is hard to digest. The Masai men tell the woman what to do and the woman does it, she has no free will as I understand it (my information given to me from a friend that has lived here for 30 years and has worked with the Masai). If the man dies, the wife has no way of supporting her family and is lost. SO, you can imagine my difficulty in answering the question but basically I left it open ended....and eventually gave him Sarah's number...ha ha ha. I mean, who knows, I could be surprised. Life is often not what it seems to be...

A bit about Charlie: Charlie is getting to know our gate keeper well (Mbutuai), saying "hi" and even letting him pick him up periodically. Charlie is very independent playing inside the gate but once we step out he is reaching up for me to hold him. In the beginning of our walks he is in my arms clinging to me as little Tanzania boys and girls come up to him, try to touch him and say "jambo toto." As we walk further he gradually wants down but holds onto my hand and after about 15 minutes he is walking on his own and I am having to tell him not to chase after the dogs or chickens. He is talking a lot too! He says all gone, all done, goat, dog, please, thank you, chalk, mommy, daddy, okay, lets go, chocolate milk (hard to understand but we know what he is saying), juice, book and the list goes on. He is also pointing to all of his body parts without help (ie. where's your eye...and he points to his eye). Charlie LOVES to play in the dirt, moving dirt from one pile to the next. He loves to throw rocks, read books, and chase after mommy and daddy. Charlie and I have had fun singing songs and performing the actions (the itsy bitsy spider, hokey pokey, etc) and follow the leader (bear walks, stomp your feet like an elephant, wave your arms like a monkey, jump like a frog, run like a leopard, walk slow like a turtle, arch your back like a cat and so on). He and I have lots of fun!

tuna kuhara

kiswahili for "we have the runs..."

Laura caught it early last week, Charlie and I are home today. But I can update the blog at least! Charlie is napping while Laura is at a bible study with Linda.

fact of the week: when a toddler develops an attachment to a blanket do not wash it unless there is a dryer nearby. He will tantrum until he can sleep with his wet "night-night".


Sunday we went to church- Laura could tell you more as I had to leave with our little wanderer. We played soccer with some kids outside. The church is right next to ALMC (the new hospital), and while Joel rounded on patients, we walked to the big grocery- Shoprite. It's about 15 minutes walk, but the way back to church with a tired toddler, heavy groceries and under a hot sun strained our composure! We cooled off with 2 cold Cokes (all glass bottles here!) and that evening we had dinner at Matt & Jane's home down the road. They are from Australia and New Zealand (respectively) working to build up the ICU at ALMC. We had an awesome vegetarian/couscous dinner with mojitos and beer! They have quite a nice place, and we sat until dark around the chimenea talking.

On Monday we had a terrific dinner at the Jacobson's to commemorate Joel's last days with Selian. Pictured L to R: Charlie, Eric, Laura, Linda, Mark, Libby, Rebekka, Joel, Bryant. Joel left Wednesday morning. Since that time I realized how active we had been covering 2 hospitals! The most noticeable change since his departure is that we instilled "tea time" into the day. And I lost my ride to Selian... The day at Selian now basically ends about 1PM with lunch and then waiting for the bus to leave at 3:30PM. We take admissions until then. I am dropped at the base of "Ilboro" road and walk home. Yesterday there was a nice little rain to cool me off on the walk. I dried off on the porch while talking with our Masi gaurd Mbutuai. We are trading languages v-e-r-y s-l-o-w-l-y at this point.

I am staying on the pediatric ward through the end of this or next week. There are several opportunities available that I still want to visit (no order here): hospice, surgery, ob/gyn, adult medicine, and the ICU at the new hospital. Near the end of the trip I will join the flight team that travels for Selian to various villages/Niarobi for medical transport. There is also a doctor not involved with Selian who travels amongst several villages that I might try to catch up with once Laura leaves Tanzania.

Monday I began care of a child with fever, abdominal pain, fatigue and vomiting. Our differential diagnosis was short: malaria or acute gastroenteritis (stomach flu). We treated the malaria with IV quinine and just pour liquid into her for the stomach virus to cover our bases. Tuesday morning, mother tells us she threw up a worm. Ascariasis! It is an intestinal roundworm that 25% of the world population carries- although this % is much smaller in the US. One dose of Albendazole should cure it. As we moved around the ward visiting patients that pharmacy cart came around dispensing medications. This pic is a fair representation of what we are working with at times. I have glimpsed through the stock rooms lately, and this is about what you will find. Last week we ran out of Ceftriaxone, an antibiotic that covers several bacteria well. Not the worst thing in the world to happen, but a headache to change numerous peoples drugs around. AND this would not happen in the US!

Rebekka (a nurse practitioner rounding with us) mentioned a book this week while performing newborn exams: The Man with the Key Has Gone. It's a metaphor to explain the slow pace of working here. You want to do something, like chart about completing the newborn exam, but there is no charting paper around- so you have to wait 10 minutes for that to be found. There is a lot of waiting like that here, no matter how fast you want to go, you will wait.

Kwa heri,
Eric

Each day as it comes...

Today Charlie and I were scheduled to go to the Step by Step house for the handicapped. The taxi was supposed to pick us up at 8:15 and the cost was supposed to be 6000 schillings (about 5 dollars). Well, a taxi didn't show until 8:45am and the driver I found out later was NOT the driver that we had set up the deal with. It was a random guy that called himself David (our taxi driver's name)...he was a taxi driver but his name was "Goodluck" and was very disappointed when I handed him 6500 schillings (I thought I was being nice)! Anyway, I think I have the taxi situation worked out...we'll see.

The time at Step by Step was enlightening. I learned that Charlie's attention span for having Mommy work with other kids is only about 2 hours and that he needs to really be at home for a nap by 11am. At about 10:30, he began to cry and get cranky disrupting what I was trying to do with the kids and their lessons. SO, you live and learn...my motto for this trip. I have decided to focus on a group activity and give 2 hours on Tuesdays and Fridays between 8:30 and 10:30. During the group activity, I plan on educating the caregivers on how to assist each child. The cost there and back is about 12 dollars each visit so that adds up too! I notice I am getting somewhat discouraged because everywhere someone is asking me for money because I am white. The gal that runs the Step by Step hinted at the fact that she needs a jungle gym and scholarships for her kids ($750 each). We have some money from the donations but the needs at the hospital are great too! The medical and peds units only have 1 blood pressure cuff between them (an example). I want to do all that I can but I realize I need to set limits. Not just because of Charlie's needs but because we don't have all the money that they need/want. I think, though, that if I were in her situation I would probably do the same thing. Mzungus (whites) make up the majority of charity work that is done here and it doesn't hurt to ask, especially when it could better the situation for her kids. So, I definitely don't fault the effort. I just want to feel that my time with the kids is enough and I am having a hard time with that right now.

Not having a car to go wherever I please has also been a lesson...it is isolating and, with Charlie, it is hard to spend much of the day walking to the market to get food (that is how long it would take). It is about a 25-30 minute walk into town and then another 20 minutes to get to the center of town where the grocery store is. Then, shopping and walking back all that without Charlie getting out to explore is near impossible. AND, I can't get too much stuff because I have to haul it back home for a long walk back. Luckily, I can get veggies/fruits at the stands just outside our place and sometimes some bread. That holds us off until the weekend where we can usually catch a ride with someone who has a car.

As you can tell, probably, I am a bit discouraged today. Hopefully, tomorrow will go better. We'll keep you updated! By the way, Eric is loving it, he is becoming more competent at the hospital and learning lots.

Step by Step

So, Linda picked me up Friday morning and we made our way to the Step by Step school for the handicapped. There, I met about 9 kids in need of physical therapy! Charlie slept in his car seat for the first hour and then woke up and played with all the fun toys they had for the kids while I got oriented. I am racking my brain a bit since I haven't formally done any pediatric therapy since learning it in school but as I brainstorm more and solicit advice from my pediatric friends (thanks, Eva....others, I need more ideas please!), I am becoming more confident that I will be able to put together a program for these kids. I haven't yet had the opportunity to do a formal evaluation of each of the kids but I was able to observe some of their behaviors on Friday to give me enough information on how I want to structure the program at least. They have a time called "physical" that is about 1 hour on Tuesdays and Fridays which sounds like a good place to intruct in a group activity that incorporates gross motor, coordination, balance and functional needs (ie. obstacle course, simon says, songs like "if your happy and you know it..."). Then, on Mondays, Thursdays and Fridays they have "Individual Learning Focus" which I plan on instructing caregivers on a simple home program for a few of the kids. I am planning on committing 2 mornings a week to work with the kids but we will see how it works out with Charlie being there and if I need more days.

I want to keep at least one day open to hopefully work at the "plaster house." It was set up by an OT that works here for kids to stay after having an orthopedic surgery. There they get 3 meals/day to properly heal and are better able to keep their casts clean.

Well, my brain is going a mile a minute. The work at step by step is consuming me this morning and I look forward to more ideas from my pediatric friends! :)

A Great Day

This morning we drove out to Arusha National Park, about 40 minutes east of Arusha, with Joel, Bryant and Libby.

It was a perfect day (80+ and sunny), although the cloud cover at high altitudes obscured our view of Mt Meru and Kilimanjaro.

We drove for some time into the park before we saw many animals, but it was a beautiful ride. The plant life is amazing, with bright reds and oranges. The trees are overgrown with vines that have adhered to their trunks- a very old growth look to the experience. We drove around Ngurdoto crater near Mt Meru and along the Momella alkaline lakes (pictured above with a water buffalo skull and flamingos in the back).

This park had several big name animals for Africa: zebra, giraffe, warthogs, bushbuck, flamingo, baboons, black-white colobus monkeys and several more. No big cats/rhinos/hippos yet!

Ngurdoto Crater


For the most part we needed to stay in our vehicle- the Selian land rover. Joel's joke for the day: What's the difference between a Jehovah's witness and a land rover? You can shut the door on a Jehovah's witness. Very true for many of the vehicles here. Charlie did very well in the car:


It helped that there was a lot to see and the rocky road kept him relaxed. Overall it was a great day! We moved around several aspects of the crater and then down to the lakes.

Our first encounter was a troop of ~30 baboons and 5 colobus monkeys. The colobus are very beautiful but hard to get pictures of due to the thick greenery. Charlie loved the monkeys and was "OO-oo-ah-ah"ing every time he spotted one. The baboons were very loud as they past in front of our car.

Once in the crater we came upon the big animals: zebras, giraffe, etc. All were at quite a distance, but for our first "natural" encounter with them it was an amazing site. Hopefully on our next safari we can get in closer, but until then here are a few videos of the trip (I hope to gain a steadier hand at filming as the trip progresses).

L to R: Charlie, Eric, Joel, Libby, Bryant

videos coming soon:
Colobus monkey- can you hear Charlie?


Giraffes

From Our Tanzanian Experiment

Flamingos

and finally, Charlie!


Have a great weekend,
Eric

ps- charlie now says "chalk", as we spend the days/evenings drawing on the porch. He is becoming increasingly more verbal as this trip progresses!

Thank you!

I forgot to write and thank you all for your comments! It helps keep us going and we love to hear from you. We are blessed with such supportive family and friends that make us stronger...Love you all!

Comment to Eric's post

This week has been hard, no doubt. I am overwhelmed with feelings that I cannot fully explain...sadness, confusion, helplessness, hope, desire, fear, protectiveness, etc! Things are getting better, though. Eric wrote that he was seeing his wife "crash." That is a bit dramatic in my mind...yes, he probably was/is very concerned. He would come home late (gone 7am-6-7pm) right from the get go without time for Charlie and I to adjust to our new surroundings with him. Charlie and I are going through a time of transition, I know that now. Slowly, as I become more acquainted with people, spend time with them, get out and learn more about my surroundings, it gets better. I had a good cry last night which was cathartic. I needed to get it out! I woke up early the next morning and felt a lot better. I packed Charlie up and put him on my back in his backpack and we set out for the morning.

We ended up walking about 25 minutes into town where I met a man named Filamino. He works at a car washing station and then uses his "disposable income" to invest in his business, a gardening shop. The "shop" consists of a piece of land in town with plant of many varieties. The plants look a bit wilted but were probably just hot from the midday sun. He says that life in Tanzania is hard. He has to support 2 kids and his wife on his income and living in Arusha is expensive for him. He is currently also going to school to be a tour guide and got a lot of practice yesterday touring me around for 4 hours! I wanted to see a museum and he asked if he could escort me. I happily agreed as he was the first person I met that could speak enough English to have a long conversation with and I have been starved for some interaction like that lately. We went to the museum of Declaration documenting Tanzania's independence in 1961 by president Nuyere (I think I have the spelling right...). He introduced a socialist state, freed the people and also ran the whites out of town. Tanzania since went bankrupt under the socialist system and is now in a state of transition (not sure what they would call their government now). People like Nuyere because he freed them but also are angry that he ran all the whites out of town because with that he ran out all the people who were educating and providing medical assistance for the people. As a result, Tanzania is filled with a majority of people that speak little to no English, many are uneducated and the health care is horrible. Eric wrote in his last email a little about it. What I understand is that many people seek out medicinal remedies from the Masai who come down for a few days/week from their villages. Others seek medical attention at government run hospitals that offer shifty care. If you want to be really well taken care of, you go to Seliani Hospitali (where Eric is working) but it costs an arm and a leg for these people and only the rich can afford it...which is something I want to learn more about. I guess they have a CAT scan (as Eric mentioned in his last post) but there is no one there besides the Australian internist that can read it and he is leaving the end of April. He tries to educate them but it is a difficult thing to do and he says that he would not trust their readings. Plus, if they wanted to send the images to someone in the states, for example, it would be impossible because they don't have a strong enough internet signal. So, bottom line, they have a CAT scan (with some missing parts...more money and more parts come) but no one to read it! That has to be frustrating. I am learning, though, that things here go slow and in no particular order. Pole, pole...a saying in swahili which means slowly, slowly. It also means something on the order of, "I feel for you," and is said often while Joel, the ID doctor, is running along the streets...he doesn't have the greatest form, is about 60 years old but runs every day. The people here are warm and welcoming and friendly. I can't say enough about them which makes the "shock" a little easier to sluff off.

Today, I am supposed to be going to a step by step house for the handicapped to assist in the morning while Charlie is watched by 2 caretakers there. Really, the perfect scenario...someone looking after him while I can do some work but also knowing that he is in eyes view. The problem is that I haven't heard back from Linda in regards to what time she is going to pick me up. Just go with the flow, Laura... I am trying my hardest. I am so looking forward to this so I hope it works out. I am trying to not set my expectations too high, though, and just take in the experience. This is still a bit of a battle but the tide is lifting...pole, pole...

My internal compass has lost direction momentarily

It has been quite a week. It feels like an understatement saying that.

After a long flight (which Charlie handled beautifully!) I was set to work early. 7:15am the next morning I was set on the road to Seliani Hospitali (Kiswahilli!) in a land rover with Joel, an infectious disease doc from California who has been coming here for some 30 yrs, Libby, a 2nd yr resident in internal medicine at U of Mn working with hospice, and Bryant, a public health administrations student from the U of Mn looking at a career in establishing hospitals in developing regions. The road up to Selian is an experience in itself. I will take some pics and talk about it more later.

With no set plan for what to do I have stuck with Joel on pediatrics this past week and will work with him until he leaves in 1 wk. So what am I doing?

I start the day in chapel. We sing and recite in Swahili and listening to a short sermon (actually I read my phrase book (Gina lako nani- "what's your name". Luckily Swahili is all phonetic) as the sermon is not in English. Then morning report on hospital news and off to the ICU (intensive care unit). This has been an eye opener as a traditional ICU has very advanced technology within a hospital. The most advanced equipment is a pulse oximeter to measure a persons oxygen level and heart rate. I have not taken too many pictures yet since I will be here a while and I don't want to appear the tourist yet. But I snapped one here from the ICU.

I might try for a better view, but this was prototypic Africa in my mind. The infant has severe malnutrition (marasmus in this case). The mother has not breastfed because she was told her testing for HIV came back positive. Testing the mother at Selian she was negative. The baby has been surviving on cows milk with sugar and tea leaves mixed in. She is hypothermic (cold) and wasted. Her face is that of an old woman and skin hangs off her limbs where fat and muscle should be. The skin on her chest is stretched taut around a fragile rib cage and she has a protruding abdomen. That light you see is like a 40 watt bulb, barely warming my hand from a few inches. That is their heating lamp. The sight is sad, but also enraging because this shouldn't happen!

The photo is also important because this is hopefully the "aha" moment for mom. She had been instructed how to feed her daughter properly but was not compliant. This is the second attempt at getting nutrition to the baby. She was taking down spoonfuls so very fast! I hope she will make it.

After the ICU we hit the peds ward- with slightly less sick children. I am seeing a lot of malaria, meningitis (brain infection), seropositive kids (+ for HIV), and malnutrition. I am also seeing several oddities, such as tetrology of fallot- a heart defect that needs transplant surgery. I am less active in care at this time since I am new and have not treated these diseases before. Mainly grabbing charts and doing the notes so I see what drugs are used for what and how management is handled. Notations are different, drug names are different and there are drugs used here that are not really happening in the US now- such as chloramphenicol. Interlaced to this are some trips to the micro lab, newborn exams and adult medicine wards. Several emotions happening each day: feeling ignorant/powerless around topics I have little exposure to, eyeballed as I walk home and get lost- the only white dude around, questioning my convictions when my wife is crashing (has God really called me to this?), and inadequate/foolish when I see such profuse poverty with the belief that I can create change. Fake it till you make it right?

After a quick lunch we drive down another route (just as treacherous) to the main hospital in Arusha- ALMC. This is the nice brand new hospital. There we hit another peds and newborn wards. Another sad case I wish I took some pics for. 10 yr old boy with AIDS, CD4 count of 7. Yours or mine is 500-1500. This is very low. He also has a myriad of opportunistic infections typical to AIDS patients: tuberculosis (TB), perianal ulcerations (HSV), oral ulcerations (CMV) and Kaposi's sarcoma. He's 10 years old and barely holding on. He was sitting in bed chewing on a cucumber with his mother beaming because he had survived the night. For this to happen in the US is a sad story, but here it appears commonplace. This is not only sad but a true problem in health care. I have been very frustrated by this case the last few days because I know we can do better by children like this. What sacrifices do we have to make in our own lives so that boys like him are not suffering? And he is suffering. Once Laura & Charlie sleep I hit the books. Malaria. Meningitis. Typhoid. Malnutrition. etc...

The staff here do good work, and the interns work their butts off. So far I am gaining the experience I set out to have. One final frustration for me that I hope to investigate while here: health care as a right vs commodity. In the curio & craft market today I met Barack. His brother needs a head CT. Selian has one but it will not work without $15,000. But the bigger issue for me is that a scan alone will cost Barrack 150,000 shillings. At his market stall he sells crafts for about 1000-10,000 shillings. Really only to tourists. And he has to eat. How can he afford that? The cost of care is prohibitive to all but "the rich" of Arusha. But the hospital needs to survive, they cannot do that without charging a fee at this time. Hopefully this gray issue will gain focus for me by May. I will try to share more about the feel of the hospitals in my next post.

As for our living situation it is quite different. We unpacked and turned on the sink- out poured about 50 ants! We drove in from kili airport to home at night. Once we left the main road up the hill into the shanty's I could sense Laura's apprehension. Linda Jacobson met us at our house with a wonderful care package, and the moment she left and the door closed there was a pivotal moment for Laura and me. Before I even looked at her, I knew what was going through her mind- "WTF!?!" How could I have dragged her out here to a dangerous corner of the world with our most cherished Charlie. It was a difficult night unpacking. Adding to the tension, I kept hitting my knee on the bed post and have since established a very large bruise. Fortunately for me, the culture shock isn't bad since I have walked in this poverty before & love the slow pace endemic to these regions. Unfortunately it appears life is going "tit for tat" and giving Laura a horrible experience for every uplifting time I have. Because of this my joy is incomplete, bittersweet. The house is nice, and our neighbors are friendly. The internet has helped. Linda has helped. I hope over this next week a calm balance will occur where we both transcend and figure this out.

Tonight was good though. Laura had a guided tour of Arusha (for free! in English!). Charlie began trusting strangers. We had a simple dinner with food bought from a neighbor. It felt so simple and good. At work I am at peace, at home we are searching for answers.

Eric


ps- Charlie is being pampered with chocolate bars and chocolate milk daily. We are wrapped around his finger tightly right now. Latest words: juice, choco, MINE!

Fun Times with Charlie

Eric left today to the hospital again and Charlie and I stayed back. It is strange not having to go, go, go and somewhat unsettling at times. I have talked to a few people here about wanting to get involved (OT that started the plaster house for kids after orthopedic surgeries to stay while they are healing so they can get 3 meals a day and not get their casts dirty while healing, emailed the peace house in regards to volunteering my time and chatted with some individuals at Selian about some possible ways to contribute). Anything that I do has to be compatible with bringing an 18 month along so it is a bit more difficult but I am hopeful that something will come around soon! SO, that means for now Charlie and I walk the street of Il Boro saying "jambo" "mambo" "habari" "pole" "mzuri" "toto" which are all greetings except for the last one which means baby. We have been invited into a few women's houses which consist of a room about 6X6 feet with a small bed, chairs/couch and a few pictures on the wall (much of the time it is a religious christian picture). The houses are made of brick, mud and tin for roofs and the floor is dirt. There is usually electricity but no running water. They walk to get there water which is usually at least 1/2 mile away, wearing worn sandals and carrying buckets on their heads. They have amazing posture...very strong neck and back muscles which could be a rehab technique with our chronic neck and back patients as I think about it now. :) Anyway, the people here are really nice but at the same time we are warned to stay in our house when the sun goes down and not to leave the compound unless it is in a car and we are getting in/out of the car when our gate is closed (inside the compound). I guess there have been recent incidents of white people getting beaten for their money and robbed. So, we just take the necessary precautions as in any place.

Eric and Charlie are currently taking their nightly shower together to wash off the deet. After that, we will get under the mosquito nets in our room and read Charlie books and play with him until he is sleepy. Then, we put him down and come out into the living room where we have lit some mosquito coils and read, talk, study, use internet. The rainy season starts in March so we will likely be more vigilent about staying under the mosquito nets at dusk than we are now.

Hope everyone is doing well. Each day is a lesson in slowing down, which is hard to do, and enjoying taking in the scenery. It is effort right now to slow down, sharpen my senses and enjoy the surroundings (thanks, Kim, for that tip). More to come later!

Our first week!

Okay, it is Saturday, February 7 and we have just spent our first partial week in Arusha. This week has been challenging as the culture shock is overwhelming. The first night I was going through ways in my head to bring up to Eric that I would like to leave earlier from Tanzania...preferably next week! Eric was thinking, "this is my calling." After a few conversations, some time to get acquainted, Internet access!, and meeting more people who are experiencing this alongside with us, I am slowly becoming more okay with staying here a little longer. :) Give me time...

Eric started working at the hospital the morning after our first night in Tanzania. Jet lagged, he got up and started at 7:15am. He starts his day at chapel and then makes rounds with the other docs, learning about the diseases and the needs in Arusha. Charlie and I have spent the days getting acquainted to our new surroundings. We live in a nice 3 bedroom house with running water. We have to boil the water to make it drinkable for Eric and me and we use the water given to us by our friend, Linda, who purifies and distills water for Charlie. There is too much fluoride in the water for Charlie's early teeth. The fruits/veggies we put in bleach water to decontaminate for 20-30 minutes and then let them dry before being able to eat them. We have a housekeeper that comes 3 days/week that does our laundry, dishes, some cooking/shopping and cleaning. It is strange to have someone come into your home doing things that I could easily do but it is customary here and I have been told that they expect the work as it provides them income. We also have a guard that guards our gated compound. This is because Arusha is so poor...we need to guard our belongings and safety. We are surrounded by people living in huts made of brick/tin/mud. They are very small and where rags for clothing. They are friendly people, saying "jambo" "mambo" "habari" and so on, greeting us. All the people, especially children, love Charlie. They come up to him and swarm him with touches in his cheek and kisses. He is starting to get used to it. In the morning he is clinging to me and by the afternoon he is walking independently saying "hi" and waving to people as we pass by.

There is so much to take in this first week, I am overwhelmed. I am also tired now as it is about 2am here and have to go to church in the morning. More writing and thoughts soon to come...Love you all and thank you for all the support!