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.