MORE Pictures!

Picture updates from the 1st week. Enjoy!

Mikkel with the fixed autoclave for maternity and Swahil quick start guide on top of the oven

DukeEngage promo shot

I worked on a suction pump Thursday. The motor was not turning on and I suspected the starting capacitor was out which is hard to replace so I retrofitted a smaller vacuum pump that I had found in a closet on Tuesday and repaired the power supply into the existing casing and rewired the motor connections. 

Standing with the fixed suction machine for the male/female ward

EWH takes a day trip to the "Hot Springs" outside of Moshi. The springs are actually a bit chilly but the water is beautifully clear and we had a great time! The group went out for Karaoke in Moshi on Saturday night and we all performed "Halo" and some backstreet boys songs on stage. 

Mercury Switch in one of the broken ovens
 

Tool bench in the workshop at the hospital

Work of the Wahandisi (Engineers)

Nkoaranga is a Lutheran hospital, so Monday morning Mikkel and I went to church. As with the church visit last month, we introduced ourselves in Swahili and talked about our purpose for being at the hospital in addition to much singing in Swahili for the short time we were there.  Afterwards, we went to the “Morning Report” in which the head doctor, Dr. Samuel, went over the new patients in each ward as well as the planned treatments for each of them.  It reminded me of the case studies shown in the Radiology department at Duke Hospital since the other doctors in the hospital all got to weigh in on the diagnosis and treatment being delivered to the patients.  Some of the younger doctors asked questions about the treatments given and pointed to “National Guidelines” apparently established in Tanzania and posted online as a source for treatment regimens.  After this meeting, I continued to work on the inventory and meet hospital staff.  I fixed a couple of stethoscopes with missing earpieces for the pharmacy and the maternity ward by shaping rubber tubing with a box cutter.  I also worked on the personal computers for Jeremiah and Neema as well as some of the other hospital staff including the pharmacy computer.  Perhaps most importantly, Mikkel and I figured out the Wifi password for the hospital so we will have communication with our coordinator, other students, friends and family, and access to equipment manuals online.  The Wifi is very slow but will be enough for our purposes. UPDATE: The hospital wifi went out on Tuesday afternoon since the hospital did not pay for the service so now we are without Wifi. 

Tuesday, Mikkel and I nearly completed the inventory, found some closets with old hospital equipment which will be useful for fixes, and toured the surgical ward to take inventory.  Surgery has a ton of equipment, both working and non-working.  The surgeon Dr. Emmanuel really wants his ultrasound machine working again so Mikkel and I are going to take a look at it sometime in the next few days and hopefully find a fix.  Seeing the closets of old equipment was also an interesting experience.  Alongside the old equipment which had clearly not been used in a long time was boxes of completely new and unopened supplies and sometimes medical devices.  Mikkel and I found three completely new steam sterilizers (essentially autoclaves that don’t use electricity but an open fire to increase pressure/heat) in one of the closets hidden behind some boxes of other equipment.  There were also new mosquito nets, surgical gauze, needles, and many other supplies which did not look like they had been touched or would be found anytime soon.  Seeing these stockpiles of untarnished equipment made me appreciate how important it will be to integrate any repair work that I do into the hospital structure and the routines of the staff.  It is far too easy for donated equipment and supplies to find their way into a closet never to be seen again (despite the potential usefulness of them), and I will try to be aware of this as I work on the medical devices here and make as appreciable of an impact as possible during my short time here.  Tuesday, I also got my first big piece of equipment – a broken autoclave from Maternity Ward. Both of their autoclaves are not working so I hope to fix quickly so they are able to sterilize their supplies again.  I’ll update soon on the progress!

Mikkel and I also began working on a puzzle since moving to Nkoaranga.  I thought it would be fun to post updates from the puzzle over the next few blog posts, but Mikkel and I both have determined, focused personalities and a penchant for puzzle-making so we ended up finishing in just 2 days. I’ve posted the pictures from the project below – Enjoy! 

Mikkel with the autoclave from Maternity

Nkoaranga Introductions

Hujambo! I’ve made it to Nkoaranaga hospital!  Mikkel and I were the first team dropped off at our host hospitals in the program so we got to say goodbye to everyone as we came to our new home.  Once we arrived, we met the hospital secretary Jeremiah with our coordinator Alex before Alex left with the rest of the group to complete the hospital drop-offs.  Jeremiah showed us to our new house for the month (pictures below) aptly named the “White House”.  Mikkel and I insist on calling each other Mr. President which has been amusing.  The White House sleeps around 20 but Mikkel and I are the only ones living here for the month, except for a few rats who seem to have made a nest at an unknown location in the house.   A group of 8 Canadians from MedOutreach had lived here for the past month doing screening work at the hospital but they moved out Friday just as we were moving in.   After moving our stuff to the house, Jeremiah introduced us briefly to the head doctor Dr. Samuel as well as the hospital matron, Neema.  Neema is very friendly and has been a great person to the previous EWH students at Nkoaranga hospital so I’m looking forward to having another “Mama Neema” in my life this month.  Mikkel and I are learning how to cook Ugali with her sometime next week.  After some more introductions with hospital staff, we started our equipment inventory to assess where we will need to be doing our work for the month.  We found around 15 non-working machines in the first few hours of the inventory.  Even more surprising was the obvious impact that EWH has had on the hospital here. Nearly every piece of equipment in the hospital had been worked on by EWH Summer Institute program students at some point.  This was clear from the “Quick Start Guides” students had created, translated into Swahili, and taped to the front of many of the machines.  It reinforced that EWH is making a major difference in the host hospitals and that Mikkel and I will surely be busy the next month.  Mikkel and I also set our workshop the first day in a large closet with some stools and a large crib that we were able to turn upside down and make into a table.  After some more department introductions, Mikkel and I went to the orphanage located right next to the hospital campus to meet the volunteers and also to see if we would be able to help with any donations.  Mikkel brought a lot of Legos and I have some puzzles and toys for older kids, but the orphanage is for kids under 5 only.  There is a secondary school nearby that we plan to donate the supplies to.  For dinner, Mikkel and I met with Rodrick, a local friend that we had met at a bar on my birthday. He is one of the administrators at St. Jude School which EWH visited last month to talk with the oldest students there about college and future plans among other things.  We talked with Rodrick for a while at an outdoor stove fire on Leganga road before he took us with another friend of his to an African Jazz bar.  We danced a lot and had a fantastic time.  On Saturday, we went to a 30 meter waterfall near Arusha on an 8 kilometer hike with 10 other EWH students.  Saturday night, we went out for Ethiopian food before crashing at the house of the Arusha students. Sunday marked the first cooking attempt for Mikkel and I and it went quite well.  We got some vegetables from the local market and made pasta with veggie sauce, chile sauce, and some mozzarella from the grocery store.  It was the first night we had electricity in the “White House” so that was exciting. The power is very inconsistent here and the hospital workday was quite slow on Friday as a result.  There has also been a funds freeze on the hospital for the past 4 months which has meant almost no equipment repairs in addition to a lot of the physician assistants and nurses leaving the hospital to places where they are able to get paid. The few doctors (around 5) who remain live on the hospital campus and show tremendous dedication to their work.  They are very busy people and have a lot to take care of with around 65 patients at the hospital most days.  I’ll update again in another post with more details about work in the hospital. 

New bedroom in the white house

Alex and I stop for a break on the waterfall hike

Waterfall in rain-forest outside Arusha

Burgers in Arusha were unbelievable

First dinner at the White House for Mikkel and I

Goodbyes and New Beginnings

Today was the final day of Swahili and engineering class at the TCDC training center.  Tomorrow, Mikkel and I will finally move into our hospital.  The last day was quite sad since I have made a lot of good friends here the past four weeks and especially with the Swahili teachers and our engineering instructor Larry.  We played basketball today against a local university in Maku Mira and one of the Swahili teachers named Mlowezi played on our team.  Despite his unreal skills at basketball, the Maku Mira team outlasted us winning 57-56.  We played on 12’ rims since apparently the 10’ rims were being broken by so much dunking.  The last day of classes here also means the last night with our homestay.  Lughano and Neema have been so welcoming and eager to show Mikkel and I the culture and language here.  They are a major reason I have enjoyed my time and learned so much in the few weeks that I have been here so it is tough to move out. Fortunately, our hospital is only a few miles from TCDC so we will still be able to meet up with them as well as our teacher Mlowezi and some other Tanzanian contacts we have made in the past month.  We also exchanged gifts with our host parents and Lulu today – pictures are below.  I’ll have to keep this short since there is much to do before starting work at the hospital!

Final Swahili class with Mlowezi. Mlowezi can freestyle rap in Swahili and it's awesome.

Basketball against Maku Mira - we lost 57-56 and "I am the Treat" was their star player.

Mlowezi led our team with Jasper and I playing in the post

Lulu with the giraffe Mikkel and I gave to her

Family picture with Masai robes Neema and Lughano gave Mikkel and I

Lughano with the Duke Soccer scarf I gave him

Ol Doinyo Lengai

This past weekend, 17 of the EWH students took a trip to Ol Doinyo Lengai. We trekked barefoot through a stream and around rocky banks to a beautiful waterfall before going to bed early on Saturday to prepare for a hike of Ol Doinyo Lengai (“Mountain of God”), an active volcano in Tanzania that last erupted in 2007.  Ol Doinyo Lengai is the only cold lava volcano in the world and the climb to the top is treacherous with an even more daunting descent. We slept at 9:30PM to wake up at 11PM and began the hike at midnight so that we would be able to catch the sunrise.  Hiking, climbing, and crawling up the mountain was the toughest single day climb I have accomplished and the view from the top of the Rift Valley was phenomenal.  The entire hike took my group around 10 hours including an hour nap on the way up and an hour at the summit to watch the sunrise.  The final crew of the day came in at 17 hours.  There was a water and food shortage on the climb, so KJ, Jason, and I hiked back up the mountain partway to bring supplies to some of the groups and added an extra 5 hours to our day.  The guides were Masai tribespeople who tackled the mountain with ease.  My guide, Elias, didn’t eat or drink anything the entire climb save a small box of apple juice at the summit. His endurance was unreal – especially considering how quickly he ran down the mountain.  After finishing, we all felt he easily could have summited again that day.  I don’t want to be too wordy trying to describe the top of the volcano and the view of the beautiful Rift Valley (fascinating history – read up HERE), so I’ll include the many pictures from our climb below. Enjoy!

Updates from Usa

Habari ya siku ningi? (News of many days?)

Hujambo! It’s been a while since I've updated so there’s lots to talk about. Classes have been very busy the past two weeks and I only have 2 more days at TCDC training center before moving to Nkoaranga hospital to begin my work there.  My Swahili is definitely getting much stronger and this past few week has been focused on expanding vocab and using a lot of the technical and medical equipment terms that I will surely need to be comfortable with next week – quite exciting!

Friday was our final trip to Mt. Meru hospital for the workday as a group.  It rained the first few hours while we were there so the group couldn't occupy our usual workspace outside. This also meant we needed to find a new power outlet which can sometimes be difficult here even at a hospital.  We found one outlet behind a bookshelf in a records room with a very old plug style that didn't fit our extension cord plugs, so we stripped the plug end of the cord and stuck the wires straight into the socket to get power for our troubleshooting for the day.  I worked on a centrifuge with Sarah and Charlotte during the morning. Then I went with a group of students and our instructor Larry to the operating room and worked on an x-ray fluorescent backlight with Louise that was only half lit.  We worked while an operation was going on in the next room with the door half open and wore scrubs to enter the clean area with all of the surgery rooms.  The “clean area” was designated by a red wooden stick across the floor at the entrance.  After this line, everyone had to be scrubbed up and wearing rubber slippers.  In the dressing room on the “clean” side of the line there was bathroom with body fluids on the floor that got on the bottom of the slippers and then people walked around the clean area in them.  Mt. Meru is one of the nicer hospitals in the area but it is still apparent that the standards and hospital culture are far different from those in the US that I witnessed shadowing cardiothoracic surgeon Dr. Cortina in Fall 2013.

Friday afternoon, I ventured into the city of Arusha with Jennie, John, and Ari to look for an internet plan for my laptop.  Luckily, we ran into one of the Tanzanian students who is currently taking the technician lab classes with EWH students at TCDC.  His Swahili is much more advanced than ours and he was able to direct us to the phone store and navigate most of the transaction for us.  It really made clear again the importance of having local friends.  It also reminded me why being an open person willing to make new friends anywhere you travel is so important and is something that I want to work on and translate to my life at Duke.

Parrot outside of our classroom at TCDC

Tuesday in lab, we taught our hospital partners skills that we knew to practice teaching
since we may have to use teaching and communication skills with hospital staff next
month after equipment fixes.  There was hair-braiding, latin dancing, and danish children's songs.
I taught Mikkel how to throw a frisbee forehand and the taught me some of the advanced settings
on my camera.

Lughano and I talked Thursday night about our plans for the future. I told him about my interest in medical research and a bit of my vision and he shared what he wants to do with his life.  Lughano first got an engineering degree, but didn't like the work so returned to school to become an accountant.  Now he works in Arusha as an accountant but would rather be running his own business.   He makes around $6000 per year as an accountant here, which is certainly enough to live comfortably on in Tanzania.  His bigger plans for the future involve returning to get a master’s in business this year and then starting his own shop or buying some of the Dala Dala buses that are crucial to public transport here.  He also wants to start a lodge for westerners staying in Usa River on some land he has already bought.  His connections with TCDC training center and westerners in the area in general would help with that.  I have also climbed Ol Doinyo Lengai (“Mountain of the God”) since the last blog post, but will save those stories for the next post. Tutaonana baadaye!

All of the Singing

                   This weekend, Mikkel and I went to church with Lughano and Neema for the first time.  Saturday night, we asked Lughano what time church started and he said 9AM, but he also said we would leave at 9AM which made Mikkel and I a bit confused. He added that church would last a long time. Mikkel and I were dressed and ready to go at 9AM but Lughano and Neema were not ready to leave until 10AM – the concept of time is a bit different in Tanzania and if an event is actually going to start on time, people will specify “mzungu time” (“mzungu” is used to refer to a foreigner/traveler).  Anyways, we arrived to church an hour and a half late and walked in as a family to the stares of most of the church audience since Mikkel and I were the only white people in addition to the only people over 6’ tall in the entire congregation of roughly 200 people.  The first hour of church consisted of songs, some in Swahili and some in English, including “When the Saints go Marching in”.  The words were projected at the front of the church and there was a lot of vigorous clapping as well as passionate singing from the congregation for all of the songs.  Mikkel and I sang along for most of the songs and the mood was very celebratory.  Next, any guests to the church were asked to be introduced, so I introduced myself in front of the church in Swahili, saying that I was an American University student staying with Lughano and Neema studying in Usa River to work in hospitals next month.  The congregation clapped a lot for Mikkel and I and Lughano and Neema were both visibly proud that we had introduced ourselves in Swahili, which was a fun moment for the family.  After the introductions, the preacher came on to give the sermon in Swahili, which lasted 90 minutes and included lots of “amens” from the congregation.  We finished with a few songs and prayers before church ended around 1:30PM.  Had we arrived on time, the service would have been around 4.5 hours, which is actually fairly typical in Tanzania from what I have heard from fellow EWH program students who have gone to church with their host families.  After church, we went out as a family to an “African lunch” in Arusha of goat leg and potatoes.  The meal arrived as a huge pile of meat for the family and we all ate with our hands, per usual.  Lughano told us that they never take any of the meat/fat/gristle off of the leg before they cook it at Tanzanian restaurants like this one, so that when you get the food all of it is still there.  My years of eating Outback ribs certainly helped out for this lunch!  

                   After another delicious dinner made by Neema, Lughano, Mikkel and I walked to the bar so Lughano could play pool and meet some of his friends to hang out.  Mikkel and I have nicknamed this bar “Chicken Bar” since they sell kuku (chicken) by the kilogram.  On Sundays, there is live music at the bar, and the singer of the band asked if I would be up for singing at the karaoke, so I had my first bar karaoke experience singing “Jambo” in Swahili at the bar (lyrics - but with Tanzania not Kenya) – fortunately it’s a popular song so I had learned the lyrics in Swahili classes last week!  

I've been bad at taking pictures this week, so here's a picture from
the Indian Barbeque we went to for 4th of July in Arusha!

Hospital Tour and St. Jude School

              During our usual Friday workday at Mt. Meru hospital, I went on a tour of some of the hospital wards. Mt Meru is one of the nicer government hospitals in Tanzania but the standards are nothing close to what I’m used to seeing in the developed world and especially through my volunteering experience at Duke Hospital. We toured the maternity ward which was missing both an oxygen concentrator and a vacuum pump, both of which are pieces of equipment that I have worked on during the 3 total workdays I have been to Mt Meru for.  Seeing the equipment missing and hearing from the nurses that they would really like to have the equipment helped contextualize the importance of the hospital work that Mikkel and I will be doing at Nkoaranga hospital which is a more rural government hospital than Mt. Meru Hospital so will likely have less working equipment and less availability to resources in general.  

             We also toured the neonatal ward which was startling on a few levels. Our coordinator Alex said that this was the first time ever he had seen a neonatal ward in developing world in which the entire room was kept at 36 degrees Celsius. Typically, infant warmers are used for each individual baby. The  sickest babies were in one room, with another room for babies with jaundice or similar less threatening problems and the healthy babies were in a 3rd room. The nurses and doctors as well as a Lithuanian lady who seemed to be in charge of the ward all worked in the sauna-like conditions to take care of the children.  People were allowed to come in and out of the neonatal ward fairly easily and we weren’t required to be clean/sanitary to enter the ward with even the sickest babies. Some of the newborns were as big as my fist and had little chance to survive I’m sure.  Like the maternity ward, the nurses were similarly challenged by a lack of oxygen concentrators, bili lights, and equipment in general they needed to care for the babies. The Lithuanian lady in charge of the ward said that they had been promised a new oxygen concentrator from a donation but had never actually received it.  The radiology/imaging department had an X-ray machine as well as an ultrasound machine, both of which were under government service contracts. Most imaging is under government service contracts in Tanzania, which means it is unlikely I would be able to apply some knowledge from my ultrasound research at Duke on an ultrasound machine here unless it was broken and the government service contract had expired.

              This week, many of the students in my program (EWH) worked with some Tanzanian university students at our training center (MS-TCDC) after our classes to give advice on PowerPoint presentations that they were going to give in English. Saturday, we also took a day trip to St. Jude primary and secondary school in Usa River, where we were matched with students in their final year of secondary school to talk about university, future plans, education in Tanzania, Swahili, English, and life at a boarding school in Tanzania.  These students are some of the top in Tanzania, and many of them will attend university in the next few years, either in Tanzania, South Africa, or America.  I was paired with Emmanual, a history and policy student who wanted to study international relations at the university level with a goal of becoming an ambassador.  I talked to many students, and each of them had a clear vision for their future, whether it be to become a doctor, teacher, ambassador, accountant or any number of professions.  This emphasis on shaping a plan for the future was apparent when talking to the Tanzanian university students at TCDC as well.  One student I talked with wanted to become an entrepreneur and the other hoped to study mineral engineering and work in Tanzania.  It’s exciting to me that planning for the future is emphasized so strongly in the schools for these students and that these students are excited about their future and have big dreams for their lives.  All of the students I talked to were in the private schools here, and they told me that the government schools are not good in Tanzania and it is very difficult to get a useful education in the government schools.  Tutaonana baadaye!

Meeting with Rebecca

 Rebecca Sauder, a summer institute participant 4 years ago, came to speak with this year’s group yesterday during our lab class. She currently lives in Usa River here in Tanzania working with a solar energy company to create more reliable power distribution systems while also managing side projects for rainwater collection with a local Rotary Club.  She had a ton of helpful tips for navigating Tanzanian culture as a “mzungu” (foreigner) as well as tips for hospital work during month two.  I’ll briefly summarize a few here:

1) Smiling, laughing and being happy go a long way to being accepted in any community in Tanzania (or most everywhere in fact, but especially here).  This is definitely apparent in my homestay, as my host parents Lughano and Neema laugh and smile an incredible amount during the day.  Their daughter Lulu is one of the happiest children I’ve ever seen – she spends most of her time while I am home laughing, making happy noises, exploring the house, and sharing everything she finds with the people around her.  Today, she persistently but unsuccessfully offered everyone in the house her lollipop. When she plays with her little pink ball, she makes sure that everyone in the room gets the ball an even amount.  It’s been truly fun and insightful watching Lulu play and learn as she is so influenced by the culture around her.  A similarly strong manifestation of the culture is the attitude of my host dad Lughano. Everywhere I have gone with Lughano, from visiting his friends at the prison guard housing to the gas station to the barber shop, he has found a way to make the people around him laugh.  It gives him a hugely diverse and strong support group in his community which brings me to Rebecca’s 2nd major point.

2) Community is everything here.  I expected Tanzanians to be much less individualistic than I was used to seeing in American life, and this expectation has been surpassed.  Last night, our TV at the homestay was having some service troubles.  If this happened to me back home, I would have called the cable company directly to speak with someone who might be able to help.  Lughano immediately starting calling friends – not even people who were necessarily affiliated with cable at all.  After an hour of this, the cable still didn’t work but his approach was telling of the community he has here.  During hospitals in month two, Mikkel and I will need to be sure to spend time to build a community.  Throughout this program, I have been told that this is often even more important than having advanced technical skills since building the trust and friendship of hospital staff will make it so much easier to find equipment available to fix and understand the equipment needs of the hospital.

3) The depth and sustainability of Rebecca’s projects seemed intricately related to how passionate she was about her causes but also the curiosity she had about the world and especially the people and culture around her.

It’s been quite an exciting and reflective week here.  I’m looking forward to going to Arusha tomorrow night to celebrate 4th of July with the other program participants and also working with students at St. Jude secondary school on Saturday. Sunday will be the first experience in a Tanzanian church service for Mikkel and I, so I’ll be sure to talk about that next time. Tutaonana baadaye!