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!

It is January 27 and I am looking around our apartment and feel overwhelmed. Charlie is now sleeping and this would be a good time to clean/pack/organize papers and belongings but all I feel like doing is taking a breather. We have been preparing for so long and now that it is getting so close (1 week!) I realize I haven't had time to let it settle that we will actually be in Tanzania next week. Many things have to happen before leaving and the list is so long it would bore you...I am overwhelmed...that's it!

I can't wait, though. I want to send out a BIG THANK YOU for all of you that have contributed to our efforts at Selian Lutheran Hospital in Arusha thus far. One of the things on my "to do" list before leaving is sending out a thank you. I will keep you all updated with how the money will be used as we learn more about the needs of the area and people. Next post will likely be in Tanzania...crazy!