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The Final Stretch

The final stretch!

Here I am writing you with less than two weeks left of my time in Tanzania. I’m starting to feel a mix of emotions.

As I was hiking this weekend, I was struck by the beautiful serenity of this country and so many of the people in it. These last two weeks I am going to try to live in the present, taking in all of the gifts and lessons this country has offered me, and filling my mind with mental images so I do not soon forget the things I have seen and learned. On another note, our apartment is infested with rats (yes, live rats), and my clothes (which I hand washed on Thursday) have still yet to dry in the cold and damp air… so I am certainly looking forward to going back home and relishing in the luxuries that are offered there which I so often take for granted (and I am really excited to see my family again).

Every day that I am here I learn more and more about the hospital, so each day is new and exciting in it’s own way. For example, yesterday as we were making our rounds about the hospital, we stopped at the maternity ward and asked if anything had recently been broken. To my surprise, the nurses ushered us in and showed us a closet with numerous pieces of equipment which had been out of service for a very long time! We laughed as we asked them “why didn’t you give this to us 16 days ago?!” Another “ah-ha” exciting moment occurred today as we dropped off some equipment in the storage closet for the pharmacy, and came across a full box of replacement parts for one of the pieces of machinery we were working on in the radiology department! I’ve realized that, unlike hosptials in America, where everything is cataologued and stored in a computer system, everything here is stored in someone’s brain. There are certain doctors who know random things about locations of parts and equipment and patients, but no one chooses to organize or write anything down. The piles and piles of useful things are messier then my dormroom! I don’t know how anyone finds anything here!

Today, we also got the chance to volunteer at an orphanage nearby. Most of the orphanages here are actually only for children ages 0 to 3, and the children are not actually orphans. Many of them have a mother who has passed away, but the father does not want to spend time taking care of them when they are so young and require so much attention. When they turn 4, the father will come collect them from the orphanage and take them home. It’s very sad, because many of the children’s mothers died because of HIV/ AIDS, and passed it on to their children during birth, so many of the children are HIV+. They were very friendly and didn’t have very many toys apart from a few tires and old stuffed animals, so they were incredibly excited by the bubbles and balloons we brought with us.

I thought I would attach some pictures of some of the machinery I’ve been working on this past week: enjoy!!

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Salama Everyone!

Salama Everyone!

It has been very busy here at Machame Hospital, I’m sorry it has been so long since my last post. We also have very limited internet in the mountains, so it’s difficult to update online. I’m in Moshi Town for the day purchasing an assortment of parts and supplies, so I have much better internet connection.

Last week, we tried to earn the trust of the hospital staff by frequently wandering through the hospital meeting different people and repairing the bits of equipment they sent our way. Some of our more inventive solutions include sealing leaks in a stethescope with super glue and siliconing a lid from one of the pots in our guest house to cover some holes on a piece of equipment.

A very exciting discovery this week was a newly donated ultrasound machine in the radiation department. The doctor in charge was using an incredibly old machine, but hadn’t taken the time to even unwrap the plastic from this new machine because he claimed he didn’t know how to use it. After lots of help from Google, Youtube, and various online translation websites, I was able to set up the device and create a user manual, with instructions written in English and Swahili! This morning, we took the device to the doctor and he listened intently as we explained how to use it and take care of it (with regular cleaning and maintenance). I’m really hoping we will get to see it in action later this week when a patient needs to use it!

A few interesting things I’ve noticed here that you all might find amusing:
1) Every young child here must take a class in English in school. When they see us, they get extremely excited to try out their English, saying “Good Morning, Mzungu!” The brave children will often run up and try to touch our hands or our arms before running off laughing hysterically, calling to each other in Swahili something which probably transltates to, “I touched a white person!” The funny thing is, they always say “Good Morning” No matter what time it is!
2) At the Lutheren church connected to our hospital, each paritioner is required to give a donation each week. However, many of the people who attend church do not have a cent to their name, so they instead bring some of their products (eggs, fruits, vegetables, and chickens!) Then other paritioners can purchase these items, and the money is paid directly to the church.
3) Everyone here carries all of their items on top of their heads. When we go on hikes or to the market, we see young children balancing buckets of water from the stream on their heads, women carrying all their groceries on their heads, and even men carrying massive amounts of firewood on their heads! I attempted this with my vegetables from the market, but quickly realized I, unfortunatly, do not have the center balance of an African.
4) When people donate clothes and shoes to Africa, women are able to go and pick up large bags of donated items, and then sell them along the streets for very low prices. People here don’t seem to mind at all what is actually printed on the clothing (as long as it fits), so it is common to see grown men in heart covered sweaters or hello kitty T-shirts. Today, I noticed a man with a t-shirt which read “2004 Summer Reading Challenge @ your Library!”, which made me laugh.

By popular demand, here is a picture of me in front of Kilimanjaro, as well as a couple of pictures I took from right outside our guest house!

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Karibu Machame!

Karibu Machame! Welcome to Machame!

A typical day as an engineer (mhandisi) at Machame Lutheran Hosptial

6:30 am: Wake up time! You don’t need to set an alarm here, because the roosters start crowing as the sun rises, and the cold will get you to hop out of bed as soon as you wake up. It’s around 35-40 degrees here at night, so we’ve started filling water bottles with hot water to place at our feet and help us fall asleep. I’m living with all Europeans here! And it is very interesting to see so many different cultures going through culture shock together, and to hear their different perceptions of what a sophisticated medical system should look like based on the schooling at their countries. My partner is from Denmark, and there are three medical students from the Netherlands and England living in our apartment as well.

7:00 am: For breakfast, we have fresh eggs and cheese, made from the women’s co-op down the street. We also have some fresh fruits and bananas we can buy at the market, and we can make porridge from leftover rice from dinner.

7:45 am: Lutheran church service is mandatory for all hospital staff. As we file in, we are surrounded by many nursing students and clinical students (the hospital has a school attached to it with over 300 hundred students from all over Tanzania!) We can’t understand the pastor, he speaks a mixture of Swahili and Chaga Mountain language, which many of the people speak here. However, the choir of students was wonderful. As they started to sing, I became very excited because although I didn’t recognize the words, I knew from the tune that they were singing “How Great Though Art”.

At the end of our first Church service, we were asked to come to the front and introduce ourselves. I really got a chance to use my Swahili! Everyone smiled and clapped after we gave our short introductions, so I felt a little less nervous and excited to get to know these people.

8:15 am: Morning Report. One really interesting thing to witness is how the hospital functions without computers. On a giant chalkboard, they write each day the tasks that need to be completed and what time the surgeries will be. During the morning report, one doctor will read off what occurred the night before: number of deaths, births, and new entries to the hospital. It’s fascinating to hear all that happened in the hospital while I slept just a few feet away in the guest house.

8:25 am: Student Presentation. During this time, a nurse or clinical officer student will present about a case they have personally been working on. The student who presented today was very clearly not prepared. He started by explaining that a child had fallen from a baobob tree (18 meters!) and broke his leg and arm. As he started discussing the x-rays, his teacher started slamming him with questions in swahili. It was funny to see how body language is the same across continents, as he started to get extremely uncomfortable and rub his face and look at his feet. The teacher made a remark that made the whole class laugh, and then stormed out of the room. I think it’s safe to say this poor guy did not get a good grade for the day…

8:53 am ish: Simona and I report to our office. It’s actually a storage room for really broken computers which were donated, and we were able to clear off a table for us to work. In the morning, we hang around our office with the door open for people who work at the hospital to stop by. Many people come through thanking us for volunteering and welcoming us to the community. I can already tell that the hospital staff (which is relatively small) is very tight knit.

10:30 am: This week, we are working on taking inventory. We have been traveling around to the different wards of the hospital, recording what is working, broken, in use, and not in use. We are trying to best assess the needs of our hospital for the best ways to assist them. Today, while we were doing inventory, we were quickly pulled into the emergency ward and asked if we could fix the saw used to cut bones in surgery. Unfortunately, it was impossible for us to repair, so that was pretty disappointing. We are really looking forward to a piece of equipment we can repair so we can prove ourselves and earn the trust of the hospital staff.

1:00 pm: We dine for lunch at the hospital canteen. It’s only a dollar for lunch, and it’s a good chance for people in the hospital to see and meet us. Also, they have Passion Fruit flavored Fanta which has become my biggest guilty pleasure here. It’s delicous!

2:00 pm: After our lunch break, Simona and I return to our office. When we arrived, we were given 2 huge boxes of broken small items which we can repair. So far, we’ve been working on blood pressure cuffs: we piece together the working portions of many different machines (it’s like a puzzle) and then calibrate them on ourselves before distributing them amongst the different hospital wards. My arm was numb for a good portion of the afternoon.

4:00 pm: We are off work and come home to our guest house! In the late afternoons, we can take a 2 hour hike up one of the many trails here on the base of Mt. Kilimanjaro. I am really taking advantage of this, and of the gorgeous views of the mountain I have from Machame. It’s said to be the very best place in the world to view Mt. Kili from, so it’s amazing that I can just see it from outside my window. We are also in the rainforest, so the hikes are simply breathtaking.
On Mondays and Thursdays, we go to the market and barter for our groceries for the week.

6:30 pm: I come home and we start to prepare dinner! It takes some time, but we have a fun time cooking and talking together. We have done a pretty good job of cooking for ourselves these past few days and really planning out our meals. We eat some form of rice and vegetables most nights and I’ve been making chapati (the traditional pancake type bread) the way I learned at my homestay!

7:45 pm: We sit down to eat! With so many cultures at one table, we never fail to have really interesting conversations.

8:45 pm: It’s time to shower, read, and bundle up with 3 sweatshirts and lots of socks so I can get a good night’s rest and be ready for an exciting and productive day again tomorrow.

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Kwaheri, Usa River

Kwaheri, Usa River!

Today is very bittersweet. I am halfway through my time here in Tanzania, and it is my last day in Usa River, before I transition to Machame Lutheran hospital about two hours away where I will be living for the next month. Machame is a very small village located at the base of Mt. Kilimanjaro, and the hospital I will be working at serves many of the people who live in and around the mountain and do not have the capabilities for transportation to the hospitals in the city.

I am definitely a mixture of nerves and excitement today. I have loved this time to settle into the Tanzanian culture, immerse myself in my homestay, and learn each day in my classes. However, I also feel ready for a change, and am itching to get to work and use the language and technical skills I have been perfecting this past month. Please keep me in your prayers as I embark on my next adventure!

Last week, Kara (my roommate) and I made a “traditional” american dinner for our homestay. We prepared Macaroni and Cheese, Guacamole and Chips, Sweet Corn (from a can haha), and JELLO! The woman who is hosting us watched us prepare it, and then yesterday surprised us by making it for our farewell dinner! It will be very hard to leave the relationships I have made and the comfort of my homestay, as well as the other students I am here with. We are all moving to different hospitals tomorrow, up to five hours distance from each other! One of my friends, Bianca, made a farewell video documenting our Safari and some of our time together. I’ll put the link here– feel free to check it out, I’m featured in it a few times… http://www.youtube.com/watch?v=_-aqPpkiL7M

I’m also attaching a few pictures of me at my homestay!

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Inafanya Kazi!

Mambo rafiki!

It’s hard to believe that I am starting my FOURTH week here in Tanzania. I feel like I’ve learned so many new things since I’ve posted last, so I’m going to attempt to fill you in on everything in this post.

Here goes, hapa tunakwenda!

1) My Swahili is certainly improving, and I am even able to go to the market and barter for supplies and food that I need! Originally, the sellers in the market charge us far more than the expected price, but they are usually pretty impressed when we are able to say “Haiwezekani! Punguza bei”, which translates to “that’s impossible, reduce the price!” Last week, for approximately one dollar and fifteen cents, I was able to buy 4 avocados (parachichi), a watermellon (tikitimaji), a pile of oranges (chungwa), and a handful of hot peppers (pilipili hoho)! For the next week and a half, all of our Swahili classes will be on technical equipment and instructions so we will be prepared as best as possible for the language barriers that will face us at the hospitals. We also learned how to tell time, which is incredibly confusing because “swahili time” operates completely differently than we are used to. They see 6am as the start of the day, or “zero hour of the day”, therefore 7am is seen as “1 o clock” or the first hour of the day. They also don’t really have a way to say minutes, so if you say you would like to meet at 6 oclock (or, noon) a person can show up anytime during that hour and still be considered on time!

2) On friday, we had a chance to really immerse ourselves in a hospital about 30 minutes from our school, Mt. Meru hospital. This hospital was much bigger than where we had worked pervious weeks, and spanned about a football field of space. One thing my classmates and I were commenting on is that we haven’t walked on stairs since coming here, because everything in Tanzania is one floor, and I have yet to see a building with multiple stories, and Mt. Meru hospital was no exception to the rule. The single story hospital was incredibly open, with all the hallways outdoors and most patient rooms having only a roof or a short wall with open spaces instead of windows. “So much for privacy…” I thought as I passed a ‘room’ full of 50 patient beds lining the walls, open for all to see. Our group was led to an office for the hospital technicians, and they welcomed us inside, where a family of kittens spunkily greeted us. Some sort of organization would have been a huge improvement, for the room was coated in boxes and piles of broken or damaged equipment. The back wall was completely stacked with “plumpy packs” a sort of fortified peanut butter designed by the World Health Organization for extremely malnourished children. My partner, Simona, and I noticed an oxygen concentrator (used to provide pure oxygen to a patient who needed assistance in breathing) which we had learned to repair earlier that week in class. Excitedly, we took it outside to examine the damages. After a few hours of replacing and resoldering broken wires, locating alternative filter options and cleaning the filters we could not replace, and a through scrubbing of the device (inside and out), we confidently proclaimed that the equipment was in great shape! To test it, we hooked it up to a gas mask and held a candle to the oxygen output to make sure it would facilitate patient breathing, and I could not help but smile as I watched the candle burn much brighter when placed next to the oxygen output.

The day was not without problems, however. We needed to make sure the machine would work for long periods of time, so we hooked it up to our power source and set our timer for an hour. However, after 16 minutes… the power went out. We turned the machine back on and soon as the power returned, only to lose power again after 22 minutes. After repeating this off an on process 3 more times, I could not imagine how frustrating being a doctor at this hospital would be– imagine trying to complete a surgery with a power outage every 20 minutes!

Another problem was in the status of the machine. A small counter lodged inside of the machine listed that this oxygen concentrator had been in use for over 80,000 hours, and the maximum for optimal usage is only 20,000. We went to the employed hospital technician and explained the need to replace the zeolite canisters which separate nitrogen from the air and provide pure oxygen for patient breathing. He got incredibly excited, thanking us for offering to purchase this replacement. We had to explain to him that we were only here to service, not to replace, and asked him to file a report to the hospital to see if they could replace this piece, because his patients were not receiving the optimal amount of pure oxygen. He nodded, showing that he understood, but his face dropped. When I returned to school, I looked up the prices of this part of the machine. Each new zeolite canister would cost about 5,000 US dollars, and each machine needed 2 canisters. My heart sank as I realized there was no chance the hospital would approve the necessary replacements.

On a more optimistic note, using our repaired oxygen concentrator was much safer for the patients then not using one at all (despite the need for replacements), so I still felt incredibly accomplished when, at the end of a very long day, we taped a sign to the side of our machine which proclaimed “Inafanya kazi”……. “It is working”!!!!

3) I am learning more and more about the culture of Tanzania, and last week Kara (my roomate) and I spent an hour preparing the traditional Tanzania dish of chapati! It is kind of like a very thick and layered tortilla, and tastes delicious. I even flipped it like a pizza by throwing it in the air and catching it in the pan!

As we ate dinner one night, I explained to the woman who is hosting us about the disappointment I felt at the hospital’s inability to replace the zeolite canisters in the oxygen concentrator we repaired. She nodded sadly, and commented how she was incredibly fortunate to never have to go to a hospital such as the ones we were working at. When Kara and I were confused, she explained to us that the hospital system in Tanzania (as it is in many developing countries) is split into a government and a private sector. The government hospitals do not fund enough doctors and technicians (and those they do employ are not paid well), new equipment and repairs, or the influx of people who attend them each day. Private hospitals, she explained, are much more similar to those in developed nations such as the United States– the doctors are paid very well and the patients are attended to regularly and thoroughly. However, that also means most skilled doctors and technicians are lost to the private sector, and the government funded hospitals, which tend to the most number of people, are left without appropriate patient care or the facilities to provide for their patients (the majority of Tanzanian people)… I understand that the work my group does here will not change the underlying issues of healthcare in this country, but I only hope we can do our best each and every day we are here to help one person at a time one piece of equipment at a time.

In other news, I swam in the Indian Ocean this weekend!

All is well here and I am excited for this week of courses and adventures. I hope you all have a marvelous monday and a wonderful week! Thank you for reading and for all the good thoughts, they are incredibly appreciated.

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Hospitalini- at the hospital

 

Hospitalini- at the hosptial

“This piece of machinery is completely broken,” the nurse said to my partners and I as she pointed at a neonatal recessitation table which was to be used for emergency procedures on new born babies. Looking around the room, I realized this was the only piece of machinery of it’s kind. I took a breathe and tried to understand the rest of my surroundings– chipped paint and a single light bulb dangling from the ceiling, baby carriages in the corner draped in bright blue mosquito nets, and a miniature scale placed in the corner made up this emergency surgery room. “we will do our best!” I replied cheerfully to the nurse as she finished explaining why the machinery was not functioning correctly, but inside I felt a little bit nervous.

This nervousness grew as we opened the machinery and began to look at its inner workings. My introductory circuit class had not really prepared me for the string of circuitry and wires which protruded from every direction of inside of the equipment. I turned to my partners, who looked equally confused, and we began to throw out vague ideas for potential problems and solutions.

As we talked, I started to again look at the outside of the machine. “may I try something crazy?” I asked. As the other girls curiously nodded, I again tried to turn on the machine. With no success, I tried holding down the power button for 5 seconds. Everything lit up, and I gasped with excitement. The nurse had said the equipment sometimes turned on, and sometimes didn’t. She also mentioned that when it did turn on, the buttons did not respond to her touch. I examined the screen again, and noticed a small button labeled “keypad lock”, after holding this down for five seconds and then changing the mode…it was miraculous! This machine was in perfectly working condition.

Excitedly, we called the nurse in to show her our progress. She beamed and had us repeat the set up process multiple times until she could repeat it back to us perfectly. This machine had been donated to the hospital some time ago, and had come without an instruction manual or translation for the words on the screen such as “keypad lock”.

As the nurse recorded our instructions and taped them (in Swahili) to the machine, I was struck by the immense simplicity of this problem. For me, an American student constantly surrounded by technology, it seemed so inherent to try holding down the power button, and to take the time yo switch the mode. However, when donated equipment comes to this rural area without instructions or translations, the equipment (though in perfect condition) is seen as “completely broken” and is useless to the hospital and its patients.

I feel incredibly blessed and humbled to have been able to witness this problem first hand… And to be able to brainstorm solutions to this and the many other problems students saw with my classmates. Our classes are going quite well, and I am learning to make full sentences in Swahili as well as engineer devices which could be useful to our hospitals (today we made flashlights!) We will continue our classes for the next four weeks while taking breaks on Fridays to practice our skills in local hospitals. Wish me luck this week– we have two exams!

In other news, this weekend I traveled to a Masai village to learn about the history of Tanzania, watched a traditional healer attempt to remove the pain in my friend’s knee with some mud and leaves, made my own coffee out of beans picked from a coffee bush on a Tanzanian farm, and practiced my Swahili bartering at a local market!

But by far the most important news of all… As I write this post it is my brother Thomas’s 13th birthday!!!!!!! He is truly the best little brother in the whole world, and I am so incredibly lucky God placed him on earth 13 years ago today and made him my brother 🙂 he is actually the coolest kid around, so this ones for you bud– to a whole year of laughter, new high scores, tons of fun, and pop tarts!