Free Pentecostal Church of Tanzania Hostel

2-16-2012

We arrived in Dar last night after a fairly grueling drive and ride.  If I say it was grueling as a rider, I hardly can imagine myself what it was like driving!  From Mikumi to the outskirts of Dar the traffic gets progressively worse.  We arrived in Dar what I imagine to be rush hour.  If it was not, I don’t know what would classify as “rush.”  Our driver, Peter, whom many of you know from your own trips is a great driver.  He accommodates the careening city buses with aplomb.  Pedestrians dart to and fro.  It is a nerve-wracking experience.  You cannot afford Valium as a driver either, or anything else that might slow the reaction time, although I cannot help but think some of the other drivers, many of the other drivers, have had something that disinhibits their brains from even self-preservation.

Along the road we did see several accidents.  Leaving Ilula, near the canyon, there was a semi a hundred yards up the mountain, on its side if I remember correctly.  I am guessing it was the product of a runaway, but with no deceleration ramp there to begin with.  There is now.  We saw a burned-out container trailer, I am quite sure was there three weeks ago and Carl confirmed it to be present five weeks ago.  As we neared Dar, there was a huge traffic jam.  As we passed, we could see the wreckage of a motorbike on its side lodged underneath the front end of a coaster bus.  We could not see the driver of the piki piki, and we presume he was extracted, but of course we do not know his condition.  I sure hope it was a walk-away!  The traffic on that side of the road was backed up for a couple miles.

Other than long and hot, bad traffic and terrifying drivers, the trip was slightly marred by the fact that one of us “got sick” (American, maybe Midwestern, possibly Minnesotan, euphemism for more graphic and colorful terms for vomiting).  We haven’t been able to figure it out.  Presumably it was food poisoning, but others had the same food.  It started two hours or so after eating and she is much better this morning, “90%,” she says.  (She looks 90% better too.)  No signs of more dire illness, either.  I am simply an observer here, so I don’t think any HIPAA regulations are trampled.

We ate at the New Africa Hotel, but none of us were very hungry.  The management did accommodate the patient with a temporary room for cool comfort.  Very kind!

The day dawned bright here at FPCT, but I promise you none of us saw it.  Carl and I were up first around 7:30 AM.  Ok, so I had been awake for an hour and I don’t know about Carl or Peter, for that matter.   Regardless, we slept “lala fo fofo.”  Like a baby.

It is 10:15 AM here, so I hope many who will read this are sleeping “lala fo fofo” currently.  We are leaving FPCT at 11.  This is after my shower.  We need not be in a hurry.  We will have plenty of time for the woodcarver’s market, Slipway and Sea Cliff at that.  Next report is likely to be from Amsterdam!  Safari Njema to us!

Ruaha and Mwagusi

2-12 to 14-2012

I asked her, “Does Mwagusi mean heaven?”  “Yes,” Connie the hostess answered without hesitation.  Can’t help but agree.  I think I would like to see how long I could stay at Mwagusi before I got tired of it.  I probably wouldn’t feel compelled to go on a game drive every day, but maybe.  I wonder if they need a camp doctor?  Bird, I think you have at least a dozen skills they could use.  Which ones should I check for on the “help wanted” board?

We had a wonderful buffet lunch with tasty salads and delicious small sandwiches.  I tried about half of the salads, all fresh vegetables.  There was also a nut-crusted veal that was equally tasty, then a small apple dessert.  That and a glass of wine topped it off.  The coffee was rich and flavorful too.

Peter did his stellar job of driving, as usual and had lunch with us.  It is 3:35 right now and we are going for our first game drive at 4.

Peter said the group two weeks ago saw a leopard.  I asked him if he knew what the word “fib” means.  Not that the big group was fibbing, of course.  Just saying….  We did see a few elephants, antelope, a giraffe and a zebra way off in the distance as we drove into the park.  The students eagerly got out their cameras.  I restrained myself from saying, “Don’t bother with those, cuz you ain’t seen nuthin’ yet!”  And we will probably see at least two leopards.  Regardless, I will be reporting our amazing animal sightings for the next two days.

We brought two kg of mushrooms from Amani Orphanage as a small gift for Chris Fox, the owner of Mwagusi.  They actually get the mushrooms they buy from the same place.

Well, if this were a plane flight it would be “wheels up” in ten minutes, so more later.

2-13-2012

We have now seen half a leopard.  Well, over half, I suppose, since half the group saw a full leopard.  Our half saw the kill and smelled it too, and when we returned it had been moved, presumably by the very same leopard.  And this does not include the woman from San Francisco who runs each morning in the leopard print tights.  We went back several times, but several other vehicles di also.  Only our other group got a glimpse of the leopard again.  And Carl got two spectacular photos.

We also heard that Ann and Phil saw fifty birds on their bird-walk.  Ha!  We saw a HUNDRED birds all at once AND they were all the same kind!  Seriously, we did see a lot of birds.  Got a couple great pictures and a new one for my “All-Time Favorites” group, a crown something, something crane.  Everyone has there fair share of great photos.

Well here we go again.  Our last drive in a few minutes, with mid-afternoon tea on the trail.  And yup, we had a great time.  The elusive leopard remained elusive, but we enjoyed the tea.  Both nights we had dinner dining on the riverbed.  You simply half to do this.  Lanterns and a bonfire, pre-dinner cocktails (with ice, if desired).  The cooking fire is built in a long, banked line of coals with the pots on the coals.  The staff stands behind and reports what each dish is.  Two words, duh-lishus!

2-14-2012

You would be bored if I listed all the animals we saw, so I will only name a few.  There was Hortense, Alvin, Edith, Bertha and a host of more African names that I cannot spell.  Elephants, lions (stalking, but not us), zebras, leopard, giraffes, warthogs, jackals, ostriches (I include it here because it is the TZ national bird and because it is big), water buck, Grant’s gazelle, impala, greater and lesser kudu (not kuru, that’s a prion disease, not big game), hippos, those monkeys with the red butts, oh yeah, baboons, water monitor (think 4 foot lizard, down-sized from my original estimate of six feet by Justen, our overly conservative guide, I’m sure), cape buffalo from a million miles away, rock hyrax (a relative of an elephant, by marriage, perhaps, because it is furry, climbs rocks and is the size of a punt pup), bands of banded mongoose, crocodiles, dikdik, and oh, so many more.  Many of the animals struck poses just like in pictures.  I think they have done this before.  A nice thing about Ruaha is the low number of vehicles you see.  At the Serengeti, there are lines of cars waiting in line to see the lion.  We saw two prides of lions and watching the one pride on the prowl was thrilling.  The lions wee down wind of the impala, but they did catch sight of the lions, did some sort of dance equivalent to nana nana boo boo and took off.  Lucky for them.  The lions looked hungry.  With the impala out of the picture, I started noticing what tender morsels we might be.  We left.  But not because I was crying or anything.

We left Ruaha by way of  another early morning game drive, but still didn’t catch sight of the leopard.  Another breakfast on the trail was scrumptious.  We ate late lunch at Neema and got to Ilula about six, all pretty bushed.  We invited a few guests including 7 from the Amani orphanage.  Anna made a great soup, enough for all and a heart-shaped cake, also enough to share.

2-15-2012

So here we are on the bus to Dar. Gifts we had brought.  We finished lunch at Tan-Swiss and have now passed through Mikumi.  Our good-bye this morning was like an Olson-family goodbye, delaying departure by a half-hour.  We gave away the many gifts the students had brought.  I gave all the crosses Bob had made to the chaplains at Ilula and gave a short closing speech. 

It was a great few weeks, by all accounts.

An Iringa Saturday

2-11-2012

Here it is nearly 5:30 PM.  We all spent the day in Iringa.  It started out just Carl and me, but then Tuli and Rita, two of the Ilula nurses, told the rest that they would be going to iringa, so with them as our guides, we all went.  They shepherded us to and from Iringa and the buses.  We took the daladala - actually, the Tanzanians call it "the mouse" because it is small - to Mtua and caught the bus there.  There are sort of three parts to Iula.  Isile is where the hospital is.  Mtua is next along the highway and a bit more commercial.  The third is Sokoni.  Collectively, they are Ilula. The whole community is spread out along the highway, between the highway and the ridge of mountains along the road.

The first stop was the BKB office, where no one was home.  We did see Gary drive by and waved. The next stop, without much pause, was the bathroom at the Lutheran Center.  I tried to get Dennis Ngede on the phone, but accidentally dialed Jake’s dad, Mike Feigal, a family doctor in Menominee.  At 1:30 AM.  I am truly sorry Mike!  At least he got to here Jake’s normal voice without panic or pain.

A little later, after I finished at the ATM and had just finished my business with Tatanca I ran into Gary.  He was standing outside the fourth bank he had driven Eunice and Tuti too on student scholarship business.  They need to hand write receipts, if I understood correctly, for all 1500 students and everything is done in cash.  Gary hopes (don't we all) to have a better accounting system by the time we get there this summer.

Then I went back to the apartment and worked on the computer.  The bank of four USB ports weren’t working.  (Don wanted to make sure there were enough USB ports on the front.  I don’t know if he has used more than the two on the front, but now he has six!  It was just a loose wire.  Took about 15 minutes for diagnosis treatment and cure.  My hypothesis is that one of the heavy cables got jostled in the transfers and pulled it out of the socket is.  Since it is Saturday, I charged like a plumber instead of a doctor.  (It is an old joke and not too funny.)

The others had been shopping and were now laden with baskets, spices, batiks, a tinga tanga (a special local style of painting) as we met for lunch.

After lunch at Hasty Tasty Too we walked back to the big bus station.  I understand the system a bit better now.  As far as I know there is no time schedule.  As the buses fill up, it takes off.  That may mean waiting until there are enough passengers or that the bus driver thinks there are enough passengers.  I asked Tuli about the passengers who would duck down.  My guess was correct.  There are regulations about how many passengers the bus and "mouse" can hold.

We caught the big bus home.  It is an hour and a half trip, and I feel like a veteran now.  We were all exhausted when we got home.  I still couldn't nap.  I am pretty relaxed tonight.

My granddaughter Parker Grace, whom I call Sparky had her second birthday yesterday.  Birdie said she came into the house and queried, “Grampa?”  Almost broke my heart!  I will be home in a week, but with plenty of fun left to come!

As I have been reorganizing for the return trip, I discovered a pair of socks in the suitcase Bev and Gary gave me to use and is staying here. I think they may be Gary's or one of the boys.  I think I should bring them home.  It would be novel to say they had been to Africa and back!

Nuts! This may be a few days late.  There is no power to the internet room.  Oh well, this is Africa!

Our last full day at Ilula

 2-10-2012

All days here seem to be good days, despite the lack of resources and terribly ill patients.

Today I gave a little presentation on the Ilula Nutrition Project – I am looking for a better name.  It went well.  The nurses and doctors were very engaged.  It helped to have Dr. Rite translate.  I got a few minutes into the talk before Mama Saga, the hospital Matron (head nurse) gently came from the back row to Rite in the font and whispered to him.  He politely suggested he could interpret.  It worked well.  I was supposed to take ten minutes, so I told the group I took ten minutes and Dr. Rite took ten minutes.

Then they played into my hands and asked many questions!  What could we do, but answer them?  We also let them sample the Plumpy’Nut.  The change in their expressions was a little like watching a kid see cauliflower and taste ice cream.

Meg Fiegal and I spent an hour reviewing a grant application she had done so I could get the gist of how they go.  Very helpful.  But still daunting.  One think we discovered is that the complete application does not need to be in, only the concept paper.  I have collected info from Institute of Agriculture and will get info from Amani Orphanage early next week.

I will publish the draft of the description, perhaps as a web page and not until I return home.

Rounds were busy.  We have seen some patients improving, which is very gratifying of course.  My sister Bev wonders who gets most out of the experience.  I hope it is at least equal parts.  Meg is doing a number of interviews for a video and one of the docs said what he wanted most from us is more to come and visit and see how we are doing!

I will head to Iringa in the morning to look at the BKB computer.  I assembled it, but the front USB ports are not working.  They did when I built it, so I am hoping it is a loose wire from transport.  I will know quickly.  If it isn’t I will get a replacement part and install it in July, when Birdie and I return.

Last night, one of the beloved suffered a laceration on the finger.   No tendon or nerve damage. HIPAA regulations prevent me from identifying Meg, so I won’t do that.  I can tell you that one of the near-physicians did a beautiful repair.  I can’t really tell you his name either, but I noticed Jake’s hands were a little shaky.  I didn’t tell him I noticed.  As I cannot in good conscience mention their names as noted earlier, I think I can say that this patient said it was the only time she would ever let this doctor work on her.  But I would!

Another hapless fool, not Meg

Tomorrow night we will party here in town I think at one or more of the watering holes.  Well, not me of course.  I have remained my staid and conservative self….  Then on Sunday morning we will head to Ruaha for R&R.  Two nights there, then overnight at Ilula to finish packing, say our goodbyes and start the trek back to Dar and home.  I don’t know when the next installment will be, but I will publish some photos too.

PS Meg gave permission and don’t let her tell you otherwise.  Jake isn’t covered by HIPAA in this case anyway, as far as I know.

 

The disappearing mountain

...now you don't.

Now you see it...

The Floating Mountain

2-9-2012

Here as I begin writing it is 7:08 AM, 10:08 PM yesterday, your time.  I wonder what your day was like?  Here we had a downpour last night.  We have had many days in a row of sunshine and no rain.  It was sorely needed.  The gardens were pretty dry and wilting.  The rain brought a halt to the progress of the nurse residence construction.  Although they resumed for a while before dark after the rain stopped, they have not returned this morning.  This is a change.  They have been starting before sunrise each morning until now, starting the cement mixer at 5 AM.  Today there was silence.  Oh, except for the arrogant rooster who struts around crowing for about an hour at that time too, just beneath our windows.  And of course the Muslim call to worship at 5 AM.  And the Christian church bells at 5 too.  Hmmm.  What time do you think Tanzanians start their day?  Do you think it is a hint or perhaps a suggestion?  Naaaah!

There are groups of children, generally segregated by gender, walking off to school, past our “rest house” as the staff calls it.  We refer to it as the more American term, “guesthouse.”  There is a fence 15 yards from the guesthouse porch.  As the children pass, they do not fail to look up to the porch.  Some respond to the Hehe greeting, “Kwameni.”  They all wear blue and white uniforms, blue sweaters and skirts or pants and white shirts.

The porch looks out across the savannah to the to the hills and mountains.  I consider this view one of the most beautiful places on earth.  We are high enough to see the savannah and trees from above, with crops and tilled ground, lush and green this time of year.  There is a mountain in the distance that magically appears and disappears in the mist.  Today it floats above the horizon.  How does it do that?  Straight above us, there are no clouds.  It is a beautiful African morning.

The workers are now straggling in to the construction site.  It is 7:55 and our meeting for prayer and chart rounds starts in five, so I will sign off.

We are done with chart rounds and another great student talk.  Will did a marvelous job on diabetes, with many good questions from the medical staff.  Now the students are off to ward rounds or simply “rounds,” and outpatient department (OPD).

I have a few more slides to finish for my presentation tomorrow.  I may ask Chaplain (I can’t spell Mchungaji, let alone pronounce it) Kikoti if I may “preach” tomorrow.  I am thinking about it.  Well, maybe not.

A couple updates.  I think I noted that some broken windows are being replaced.  Some of the windows are as well, but I don’t know at what pace.  The new ones are nice metal sliding panes with a screen.

Emmanuel, the lab director just gave me a nice long tour of the lab.  We really can do many tests here, thanks to him.  The hospital has plans for, first, a lab remodel and later a new building to accommodate the increased business and keep things up to date.

Randy, I have not yet checked on the Cryptococcal Antigen tests yet, but will tomorrow.  Gary, I have sequestered your modem.

It is 5:30 PM here, Kili time.  Off to the Peace Garden.

We get used to things….

02-08-2012

Which is not necessarily a good thing.

Today we were finishing rounds and Will noted workmen were replacing glass in a number of broken windows today.   Randy (I think) aptly noted to Dr. Saga, that to help keep morale up, things like the broken windows need to be replaced.  How true. 

I noticed them the first time I made rounds, but quickly got used to seeing them.  Many of them were hazardous, as Laura B. pointed out, with many jagged edges.  With children running around there was a true potential for injury.

Laura also noticed that not all the beds have nets and many of the windows do not have screens.  Except for the broken ones, the windows do have glass, but they remain open because it is simply too warm, even at night to close them.  They need screens.

I was looking at the walls and cement floors and thought how each could use a coat of paint.  The gray of the floors keep the general ambience drab, despite the worn but pleasant yellow walls.  Joann Sjogren asked me before I left to Tanzania about sheets for the beds.  All I could remember was that patients use colorful kangas as covers.  I am pretty sure they use their own kangas.  Joann, I did notice they use white bottom sheets on the mattresses.  These all have someone else’s logos or names on them.  They are the heavy, industrial kind of sheets. Today on one of the wards, most of the men had gone home and the sheets stripped, exposing the torn rubberized mattress covers, some of which barely hold together.  All of the beds are old-fashioned.  Nothing wrong with that.  They are reliable and simple to use.  But many have multiple coats of chipping paint.  And some are the simplest of metal frames with wooden slats.

Now I remember why a visit to Tanzania is a life-changing experience.

Of course there are many priorities ahead of these things, especially the care of patients.  Our students have done a marvelous job with their presentations – I know I said it before, but it cannot be overstated with this fine group of people.  I am sure that the pharmacy students will come back as faculty (assuming they get a passing grade from the old faculty member here, which seems highly likely).

On Friday, I get to speak to the doctors and nurses myself, this time about malnutrition and our hopes for the use of RUTF (Ready to Use Therapeutic Food, in case I haven’t pounded it in hard enough!).  I will have ten minutes to describe the protocol.  All the doctors and nurses I have talked to are aware of the need and are enthusiastic.  The main problem will be the cost of keeping the RUTF in stock.