Education Outreach and Student Training

Priyanka and I spent a lot of time preparing the presentation (on STDs) that was requested by the Nyanza Secondary School. Conducted the talk to a small group (they will then talk to their peers) in the new IHP Birthing Center. We covered all the big ones plus HIV. Kids very interested in HIV history and new research, so we discussed role of male circumcision and PrEP. Seemed to mostly go over their heads but if even one person picked up the main ideas, it was worth it Pictures forthcoming...

After we conducted training, we received some. Jackie, a visiting nurse at the clinic did a session on scrubbing-in and surgical prep. Dr. Charles Powell (neonatologist) gave us a talk on neonatal resuscitation. "Airway-airway-airway... breathing-breathing-breathing." Very good talk, I learned a lot in spite of being a lawyer.

Milkman

Every day, there is a little bell around 3pm and the milkman rides by Paula's house on his bicycle in case we want any milk. One day when Paula was buying I gently bullied him (and gave up some coin) into taking a picture with me. He must ride gazillions of miles a day with those jugs... We boil the milk first, don't worry. Which means we only drink skim milk! :)

Trip to Market

We went to the Buzuruga (suburb of Mwanza) produce market last week. Here is a picture of a typical stand. They also have enormous avocadoes and lots of home made honey. The mangoes here are ridiculously delicious.Also, before I left, we talked to an old vendor ("bibi" or grandmother) who taught me to shell peanuts properly. (below) I heart her!!

Those kids in the top of the shot followed us around the market, curious and excited, like we were some new zoo animal. Unlike the one girl who was terrified of my crazy white face. Poor thing..she cried!

Day 19 – Tuesday Hedgehog

Finally found the mile run around the compound! Many fun encounters. School kids en route to class tried to run along for about 0.3mi/ One family tending their plot counted my laps each time I passed, laughing their butts off. What appeared to be a mom, grandma, and two daughters stopped my mid run to exchange foral greetings, shake hands, and welcome me to Nyakato. Out of breath from replying to greetings mid-run.

Tried to get $ from ATM today but no luck. Some SparrowNET crap. Ugh. If I could find that sparrow with its net I would smack it silly. Went to a Maasai jewelry shop with Paula. So many beads!

In clinic today, some boys dropped off a request for an STD lecture for secondary school students. Priyanka and I will be working on that for Thursday. Yay!

Also, I ran into a hedgehog after dinner. It sniffed in my direction.

Something bit me...

I sat down for a game of Scrabble after a long day and what do I find on my knee but a huge bug bite. Please don’t tell me this is a spider. I took my Mefloquine MINUTES after I saw this. Blegh. Still alive though.. Doctor said this was an "idiosyncratic reaction." For as medicky and scientificky as that sounds it just means "you have a weird bug bite mark, congrats." Will monitor for further developments.

Day 18 – Monday chores and horrible creatures in our bungalow. ACK!

Ran around town with Paula and Mboto again. So tiring... I don’t know how she does it. During our trip, Paula explained the problem with clinics accepting HIV/AIDS funding to supplement a rural clinic with an ARV dispensary. Apparently the stigma is so great that a clinic with an HIV/AIDS “wing” cannot survive as it will likely lose its “general care” population. The only organizations immune to this problem are hospitals, which are enormously understaffed, filled miles beyond capacity (2-3 patients to a bed in the Bugando maternity ward. A bed!!!) and not in close contact with the community.

Priyanka found a giant tarantula in one of our bathrooms, right on the shower drain. He totally stared down the camera. Yes, I squealed!!

Then, just as we were calming down from that experience, Sarah walks in and says, “what’s this on the floor?” The “this” was a giant millipede, about 6 inches long. At least! I know it looks small but compare it to the power strip!! I tried to pick it up with a cup and it wriiiithed. So I REALLY squealed. The night guard came up to our door/fence with the machete unsheathed and ready to rumble. I handed him the cup with the curled up millipede. His eyes showed no sympathy with my emotional condition and he nonchalantly flung the milllipede into the bush in front of my house. Frank, I want to move to Iceland...and also someone needs to call me a WHAAAAAmbulance! :(

Day 17 – Sunday! Pool! Tunza!

Priyanka and I cleaned the bungalow. The soot from Mwatex was everywhere! After that we took a trip to Paula’s pool to soak our feet and then the whole group went to Tunza, a lodge/restaurant on the beach of Lake Victoria where it’s actually okay to walk barefoot (if not swim). Here are some shots of the sunset.

JJ (a good friend who is also the son of one of the staff members at IHP) and I also had some fun hamming it up for the camera. JJ speaks fluent English and Swahili. He is 6. I feel dumb.

The Dala Dalas

A “Dala dala” is a bus that goes around Mwanza and its vicinity. It’s actually more like a glorified van. For just a few shillings you can go to most places in town, with only a few caveats such as terribe drivers, buses packed so full people have to disembark via window, and pickpockets. A major plus is the bus “personality.” My personal favorites are the “Dogg(y) Style” bus and the John Cena bus. John Cena is HUUUGE in Mwanza. I don’t know either...

Day 16: Temple Visit

Another trip to Mwanza today! Visited a Hindu Temple with Priyanka. The woman (Neesha) who sells Paula her plastic chairs gave us a tour of the temple. Fascinating and kind of tiring with all the deities. Neesha was a wonderful and gracious guide. The temple was cool (temperature wise) and super clean. Touched a cow sculpture/fountain for the blessing. There is a very large Indian community in Tanzania, but mostly in urban areas. Many businesses are Indian-owned. These are not expats though!

A large group of new volunteers arrived from Iowa today. We were running around like crazy trying to help IHP get ready for them.

Day 15: A jog and a scared patient

Ran for the first time today. New volunteer likes to run too so we could go together. There is supposedly a 1mi lap around the compound but we couldn’t find it so we just did laps inside the compound, about 0.3mi each... Tired from saying hello to the guards in Swahili every frikkin lap and the Merrills are..ahem... not running shoes. I’m going to have glutes of steel from this.

Was supposed to observe an incarcerated hernia surgery today but no dice. The woman did not show up, was too scared. The clinic does not collect patients’ phone numbers or addresses so we couldn’t call and see what was going on. One of the things I think will change by the end of this summer...

Views of Mwanza and Driving

I've been slowly collecting city photographs over the past few weeks. Here is a collection of shots from our drive from Nyakato into Mwanza proper and some downtown Mwanza pictures as well... Mwanza is the 2nd largest city in Tanzania but the scenery just outside town changes from urban to rural very rapidly. Jeans to goat herds. Small "shops" are very common, such as where the man is sitting under the umbrella selling small wares. These may be fruit, small tools, or t-shirts. We also noticed a huge quantity of Coke brand (Coca Cola, Fanta, Dasani) ads, painted on buildings and homes, as sun umbrellas, and even painted on boulders jutting out of the hillside.

Most of the roads in Mwanza city are paved, with the obvious exception of "rough" street. Roads outside town, except the highway, are not paved. Apparently the Japanese paved these roads as a (successful) strategy of generating new customers for Japanese cars. However, people prefer to sweep and splash water on walked areas to keep the dust and debris down. People commonly walk alongside the highway as well as ride bicycles or push/pull carts. The traffic can move pretty fast when the road is empty but it can get very congested and people don't frown on passing using the opposite lane even in heavy traffic. People just kind of shift out of the way. Honking is not very common and angry yelling is even less so; almost never, actually. Driving LOOKS very hazardous but I have yet to see a single auto or pedestrian collision (knock on wood).

1) not REALLY from Texas...
2) View from the road just outside Mwanza city.

3) A look out of the back of our Land Rover onto Rough Street.

4) A typical store on the side of the road.

5) A view of the lake from Mwanza city, not far from the center.
6) The rice is drying on the side of the road in Mwanza suburbs. Lots of rice farming here.
7) Central roundabout in Mwanza. The "sick fish" fountain as Paula calls it.
8) A typical Coke stand. Lots of those.


9) A taxi stand in front of a secondary school. Way in the back, you can see the large brown building. This is Bugando Hospital.

10) My favorite children's store in the WORLD. Note it says "BABY" behind the thing with the ears... Oy.

Days 13-14: Observing Procedures!

I shadowed Dr. Jones in clinic this week and observed both diagnostic interviews and 2 surgical procedures. The clinic can only accommodate local anesthesia, so I stood in on an adult circumcision and a simple suturing procedure for a boy with a deep upper lip injury. Watching the surgeon perform the procedures and simultaneously train the clinic staff was fascinating. It really brought home the importance of good lighting and hygiene even in a small suburban/ rural clinic. One stitch in poor lighting can make a huge difference in a person's life.

Feral Dogs, Cats, and Butterflies

The wildlife here is almost overwhelming. The most entertaining "neighbors" have been this feline family. They're wild but not shy about strolling by just after breakfast to see if you might leave some food out. Paula and Denny are not fans of these cats because they hunt the birds and of course likely have fleas. I caught one napping by the screen door near the kitchen. This is the mama-cat. Possibly pregnant...

I also saw this pack of wild dogs just across from the clinic on my way from work. They are a good example of the Tanzania Terrier, as the locals call them. I don't know if the breed is named officially but this is what all dogs here look like. I think I'm lucky these didn't eat me...

On the walk from the bungalow to the clinic, there is a spot where I always see the same butterfly. Here it is...

Days 11-12: Busy Clinic

Monday was crazy. The main registration/ billing person was out sick so I had to learn pretty fast and assist the head nurse as we managed the influx of people. Not only did we have a lot of walk-ins, but 2 local schools decided to bus in their students for check-ups. The school pays for the students' consultation fee.

Here I am with Miriam (to my right) the head nurse who knows everything there is to know about the clinic and who paaatiently taught me reg. and billing procedures (as well as some Swahili) on Monday and Victoria, a physician here at the clinic, to my left.

Tuesday was a little lighter in terms of patient flow but I was still busy as I pushed to finish my patient records project. This is a shot of me and Mariam, the Queen of Registration and Billing (she does more work in a day than most of us in a week) after I FINALLY finished re-alphabetizing the old charts. The charts themselves are to our right in the boxes; what you see is about a third of them. The clinic opened in 2006 and so far there are 24,500+ patient records on file.

To our right at the top is a picture of current President Kikwete and to the left, the older gentleman, is Julius Nyerere - the first leader of Tanzania after the country gained independence. Many offices in TZ display both photos as Nyerere is on their currency as well. The interesting thing about him is that, as President, Nyerere was outspoken about trying to make sure his family did NOT follow him into politics and pretty much prevented his son from running for national office. This was in order to protect Tanzania from "big man" politics that has infected so many other newly independent African states.

Next I worked a little in the diagnostic lab (the clinic runs HIV, pregnancy, urinalysis, stool, and blood sugar tests, among others plus pelvic and abdominal ultrasound exams) and called it a day. Not many people seem to get HIV tests (a small handful a day, at most)... may have something to do with the fact that they have to announce they want the HIV test done and pay for it in front of all the other patients. The clinic is too small for private conversations with the patients and written forms are not the norm because of the high illiteracy rate among patients in low-cost healthcare settings. So, the norm is loud - and very public conversation.

Day 10 - Sunday Dinner at Dr. Bon's

Dr. Bon (as in Boniface) invited the volunteers for dinner at his home in Mwanza. He lives up on a hill that would be a hiker's dream. His brother drove us. We had the local fare (beef stew, fried fish, rice, cabbage, cucumber salad) plus the best drink I've tasted EVER. A fresh pineapple + avocado smoothie. We polished off two jugs of it in the first 10 minutes. His wife is gorgeous and the kids charming. I was definitely not that good as a teenager. Dr. Bon is an avid soccer fan and (apparently) like most of the men in Tanzania is waiting for FIFA World Cup 2010 (in South Africa) with the game calendar neatly folded behind his TV. His wife is not an avid a fan, shockingly.

On our drive to Dr. Bon's, we saw the ONLY jogger in Mwanza making his way up the road. Poor guy...everyone seems to know him and everyone kind of laughs. :/

Day 9 - Saturday Trips to Lake Vic and Dancing Rock

Clinic is open half day on Saturdays so we put in the hours; it was busy! Afterward, however, Mboto and Dr. M took us out for some sightseeing in Mwanza! Here is a view of the lake from the road:







1) The pier (like a fisherman's wharf type of thingy) at Lake Victoria. Smelly smelly but amazing birds and views.













2) Park overlooking the lake It was peppered with some cow patties but otherwise beautiful. You can see some locals behind me doing their laundry on the right. We try to not take pictures of the local people unless it's unavoidable (i.e. they walk into the shot) or they give their permission. Not only is it rude to objectify them like that but you may get yelled at or cursed by a Maasai. Not cursed AT, mind you...cursed as in "abracadabra." So, anyway..this is me at the park.

Some likely schistosomiasis vectors at the beach (3 feet from swimming locals)








3) Dancing Rock!

The drive up to "Dancing Rock" in Mwanza was so scary I had to look away. Below is a picture of the road to give you an idea of the drive. You have to hold on because otherwise you will whack your head on the window or fellow passenger's noggin. Saw many goats and even piglets in the homes we passed. The horse is a dashboard bobblehead. I have no idea either...





The Dancing Rock itself is a complex constellation of enormous boulders that peak to a vista overlooking Mwanza as well as the Lake. My picture with Yelena really doesn't do it justice, the view was so so vast. I will upload other pics when I get them from the fellow volunteers.
On the other side of the vista there is a HUUUUGE boulder. The only person with ballz to climb it was a teenage girl (WIN). It's difficult because there are no footholds and you kind of have to scamble like a gecko. We cheered her on and she was shaking with giggles the whole way up. Here she is at the top. Good job!!
After the trip we were hungry and tired and decided to go to a highly highly recommended local restaurant. Well, it sucked. We sat for 3 hrs looking at this:
Tai Five restaurant is ass, don't go there. I never got my Ughali either. >:/ Separate Eugi from her food and she shall FLAME you!

The Party Scene is so NOT off the hook... :) Pool Bar and Rockman Pub

Went to Rockman Pub with the 3 fellow volunteers, a new and relatively spiffy local establishment. We were served Vladimir Vodka (distilled in Tanzania) and Fanta. They don't pre-mix your cocktails, just bring the ingredients. I mostly chatted with Mboto, who is the IHP driver extraordinaire and was so patient for hauling us there and back. FYI, I am NOT drunk, I'm just squawking directions for the person taking the shot on where the "big button" is. :D

That is a carrier pigeon on my shirt, if you're curious.


A few days earlier, we had stopped by the Pool Bar here in the village (I don't think it's an official name - just that the little lodge has a pool table and a clean quiet bar) where Y and I were pretty entertained by the very correctly dressed woman on the Toilet sign.

Note the covered up knees and shoulders! (Jeanhee, I can hear you laughing from here...I couldn't help myself, okay?!)

Day 8 - Family Planning Clinic and Village Market

Instead of work today I joined Paula on a trip to Mwanza.

We visited the city Family Planning Center where the Nyakato clinic and others like it receive their contraceptive supplies. In order to receive a batch, the clinic must supply a report of how the previously-received batch was used. I'm assuming this is to prevent overpurchase and resale of supplies...









After that, we had to drop my housemate and fellow volunteer R at the airport but before we let her go we had lunch at one of the outdoor spots just by the airport building.

We each got a HUGE plate of (local) rice, plus beans, tomato sauce, spinach, and I ordered fish.They served tilapia from Lake Victoria. Even though you can't swim there, the tilapia is too good to pass up. Don't ask me why I'm making my rabbit face. I confuse "hungry" with "rabbit" for some reason...

Day 7 - 5/20

Picked up dress from the tailor. Looks good (will add picture, don't worry). Also after dinner saw the Big Dipper. It's upside down here!

Days 5-6: Work and Mwatex

The Nyakato Clinic where I am working is located on a plot of land bordering a textile factory called MWATEX. No scrubbers to clean the smoke and the chimney is fairly low, given the density of the smoke and the amount of crap the chimney pukes up every day.

Here's a taste. This is a view from the clinic. Where sick people are breathing.... And yes, lots of respiratory illness cases at the clinic. Just a random correlation, I guess!View from the worksite at the Patricia Ward (under construction), on a different day. As the ward is being painted inside you can literally see the soot settle on the first coat of paint.
The funny thing is they sell the fabric mostly in India, so local ideas to boycott the textile factory have pretty much died out.

Working out at the Bungalow

WOD:
x10
1 min burpees
1 min squats
1 min jumping jacks

[+100 V ups ]

My luxury gym facilities. My overjoyed face.

I better make it up Kilimanjaro dammmmmit!

Day 4 - Mon 5/17

Worked in clinic all day, at the registration/ records/ billing office. My project is to review/ re-alphabetize the files in a-z order. The system is kind of multifaceted. Removing duplicates and making sure med histories are complete and easy to find. More than 20,000 records at the clinic and it's only been open since 2006! Many new walk-in patients daily...

Lots of upset kids, but clinic does dental extractions and circumcisions so I hardly blame them. Finished up around 4, only done w/ about 25% of the files, but covered in dust and bug poo from the file cabinet.

After work, went to the local tailor in the village. It's about a 15min walk. Tailor shop is next door to fabric shop. Each is basically a room. I now have a very accurate mental image of what a sweat shop is. :D There was mucho sweat, literally and figuratively, in those shops. Anyway, I got a large swath of fabric and ordered a dress. Total cost for everything - $7.

Here is a picture of Y and me with the tailor shop staff. They are fantastic and super friendly. If you are in Nyakato, you MUST go spend your shillings there. :)

Day 3 - Sun the 16

First real weekend day. Jet lag made me get up way early so I did some chores. Chores are therapeutic (Frank stop reading now lest you get any ideas) around here. Loads of laundry, sweeping and taking out the trash - 3 cans: one of burnables (paper etc) to the burn pit, one of plastic/metal to the bury pit, and one of perishables (i.e. food) to the compost pile. National brand (Kilimanjaro) beer and plastic water bottles (Dasani) are kept for return to manuf. for a refund.

Was peeling potatoes in the kitchen and saw a family of mongooses sniffing around front yard. There are snakes around here they eat and also bugs, obviously.

L, Y, and M, other volunteers, arrived from safari today. They were thrilled with the trip.

Just before bed, finished my first book started here: "Adventures of the Hunt Sisters" or something. It's okay but has this quote that I can't get out of my head: "...hope is neither false nor true but a kind of happiness in itself, a fuel that carries us towards our dreams."

Day 2 - Saturday - Worked at Clinic

Got a tour of the clinic on Sat (busy) and worked the day in registration, filing patient records. There are 3 different filing systems and over 20,000 records. Looks like patients have the option of keeping their original record with them or leaving it at the clinic. Interesting, from the perspective of privacy...

Chief complaints seem to be malaria and typhoid, with lots of suspected malaria. some reluctance to get HIV tests, but without outreach to encourage and de-stigmatize it, I'm not entirely surprised. I WAS surprised to learn that condom use is believe (locally) to do very little for preventing HIV transmission and MORE surprised to learn that this is true, because someone came up with the bright idea of reusing the condoms instead of buying them time and time again. Tell me again about why the free market is better than subsidized access to certain health care needs?? ;) Clinic does (and plans to do more) outreach and education to local students, although resources are scarce. Clinic also does dental extractions.

Overall - very very busy, but patients are tremendously patient. Service appears affordable but not free. Groups of children come in from nearby schools and orphanages. Info about the clinic was originally advertised in town (Mwanza) but now mainly spread by word of mouth by distributing flyers to women at the local markets (seems more effective).

More later...

Day 1: Working on the Patricia Ward

I spent Friday painting a suite in the new Patricia Ward for clinic patients. Right now the clinic is outpatient only, trying hard to expand (nearest hospital is at 120%-140% capacity).

I had neither ventilation nor a mask, so please excuse my paint-huffed crazyface. The electrician who took my picture was laughing. But I learned words from the other workers - nusu is half (i.e. I need another half a bucket of paint, yo) and nzuri is good (i.e. good job finishing the painting without passing out).

P.S.: Note how much the gloves have helped ensure I don't get any paint on myself. Yes, that white splotch in my hair is paint, shuddup.

Fire Ants for Breakfast

This is near the end of the rainy season in Tanzania. The day I arrived saw some rain. The ants don't like the rain because it floods their little ant caves and their little ant babies get the sniffles. Or something. So they "migrate" something around 10 feet to a lightly higher elevation (i.e. out of the mud puddle). Of course, the 10 feet they choose are exactly across the path from my bungalow to Paula's house, i.e. my breakfast trail. Uuugghh...

Did I mention fire ants can eat your freakin' leg off? So yeah, I BROAD JUMPED my butt over those guys. I must have set some kind of record for "jumping over fire ants en route to breakfast." Tough day. (Second pic is zoomed in. They way bigger than regular ants!)