It has been over a month since I blogged, and it feels like a lifetime has occurred during those weeks. November really was a dichotomy, it was full of social gatherings, parties, beer and laughter; yet it was also had a sprinkling of frustration, incomprehension, sadness, and loss.
My month started with the surprising arrival of Uli, a lovely German girl from Munich who works the lab we send our tissue biopsies to. I had been aware from an offside conversation with the administrator a month after I arrived that she may be coming, but I had no warning of when and for how long. To add to this the Tanzanian time for going on holiday for 28 days straight was fast approaching, and so our staff numbers were dwindling! Also my colleague Monica was going to be away for another course. Therefore, I had to use my noggin and quickly arrange a timetable and find someone in the lab able to communicate with broken English, and reciprocally understand her broken English too!
It was rather difficult, and although the staff tried hard, Uli would often return to the office to find something to do. I asked her what objectives she had for during her month here, and she said she wanted to see tropical diseases and their diagnosis. I explained that although the lab had some automated analysers, the work was very simple, and for a trained western scientist, it would soon become mundane. She took to reading malarial slides very well, and was very helpful in that department, but I think she was surprised that not everyday is filled with a multitude of strange tropical diseases caused by intestinal worms, or blood parasites. However, she found enlightening enjoyment by joining our outreach team on trips around the area testing for HIV. Soon her thoughts changed from wanting to work within the laboratory, to experiencing the surroundings and culture that the outreach visits provided. It was great to see how her expectations altered with each experience, and in her final days here she said that she really had no concept of the work here, and she truly believed that you could never understand it until you experienced it for yourself. I had to agree wholeheartedly with her.
I was also excessively busy. It seems after 3 months, I had finally settled in enough, and understood enough about the lab to fully comprehend the extent of the work I had to do. It is tricky because there are lots of ideas I have to help in small ways to improve the services and the working environment for the lab. Yet often extraneous circumstances draw me away to other problems! November was definitely a month for them!
I had aimed to write what we call standard of operations for each test we do in the lab. I was able to complete a few, but without the presence of my colleague Monica. I had hoped to teach her the finer details about writing such things, but as ever she is very busy with supporting the work within the laboratory. I also created a new disinfection protocol for the laboratory, and trained people on how to make control slides for all microscopy tests and how to use them. Writing this now, I feel better as that sounds quite good, but as ever here, things take form slowly, and reiterating the importance of it and following up things continuously is required. It is not because the staff are uninterested or are lazy, but people are creatures of habit. Therefore, you must make an action habitual before they routinely remember it.
During trying to do these things one of our donors decided finally to give us a supply of very needed reagents, but with the arrival of some, the need for others took their place, and thus I was in constant contact trying to arrange for these items to be bought. They call it emergency procurement, but due to disputes about lack of monetary transparency, and political wrangling, some items have been requested for nearly a year and still there is no sign of them. This is coupled with some people’s inability to reply to emails in less than two weeks! I realised however that they often call Monica, instead of replying to emails. It makes me realise even more how important she is to the effective running of the lab. I may be here to assist her on certain things, but she truly has ways of getting things done that I would never be able to achieve…she is truly the boss, and I call her that. She laughs at me and says I am…but I am really am not in the slightest!
Aside from reagents, the main blood bank in Mtwara had difficulty collecting last month due to school exams. Collection is normally from school children, as their blood is often the safest. Therefore, more donations from patient’s family members had to be conducted. However, we ran out of Hep B rapid testing kits, and thus donation was occurring without testing for it. I found it very uncomfortable and still do, but as our surgeons and doctors stated in life and death situations, such problems become insignificant. I now am starting to understand and adjust my expectations to reality, just like Uli!
To top the lab problems off, our CD4 machine used to assess the CD4 type of white blood cells in HIV patients started to become sickly. We tried very hard to make it better, and during this time, I have become an expert in this machine! Monica and I then had to find out about if we could obtain a service contract from the Ministry of Health for this and another analyser, as currently there is none. Therefore if they need repairing we would be unable to fix them as the hospital is unable to pay. We are getting somewhere slowly between Monica and I, but are still waiting, and praying the machine can keep working for a little longer.
Even through all these little problems the staff still keep me smiling. I really feel at home with them now and I am able to understand enough Kiswahili now to join in with the jokes and some conversations! This part is very important to me, because I want to come away from this experience knowing that I tried my hardest to be part of something both practically and socially.
Away from work, November saw the month long goodbye celebrations to Barbara and Tony. They have been here in Nyangao for just under two years, and decided to go on Safari before returning to unsure lives in England. One weekend we had a lovely leaving dinner in Ndanda with other volunteers. We all contributed a dish, and it was sooo good; I was in heaven! I had not felt that full in eons! The next weekend Tony, Barbara, Uli and I went to the beach house in Mtwara, and treated ourselves to full English breakfasts, nice dinners, ice cold beer, swimming, snorkelling, and most importantly sleeping! I really needed the break, and it was great fun to be able to show Uli around, and with her there I had more confidence to try my Kiswahili, and explore the shops and even go to the post office! It is strange, but when your in a pair, even if the other person has less of a clue than you, it seems to make everything less intimidating!
The next weekend, the hospital staff laid on the official leaving party for Tony and Barbara. It is much like the birthday parties I described in my earlier blogs. We all sit facing the head table where the guests of honour site, including the doctor in charge. Then the MC says a lot of thanks in Kiswahili, and each department of the hospital presents a zawadi or present by dancing in a conga formation up to the guests of honour. It was really special, and everyone had a few drinkies and a great dance. I ended up staying later with Monica and her husband, and I was complimented on my dancing ability! I was quite pleased for the compliment, and now as I can identify more songs, and have seen the local dance moves, I think I can improve even more!!!!
Tony and Barbara left on the 1st of December, but I will see them in two weeks when I get to go to Dar es Salaam for our annual volunteers conference….and maybe Zanzibar. I can not wait. I think it is time I leave the South for a little while. Then I can fall in love with it again when I return!
Saturday, 1 January 2011
Sunday, 31 October 2010
31.10.2010 I danced like a white European, and I did not care! (Well maybe a little!)
It has been fairly quiet the last few weeks. I have been busy getting stuck into work, and it seems that we are seeing more and more patients every single day. My colleague Monica is needed to work in the lab, and so I have been unable to work with her. I have been filling my day with writing out health and safety policies, and standard of operations for testing and quality assurance in the laboratory….(yawn!). So as you can see, I was in desperately in need of fun!
This came in the form of a joint 50th birthday party for two doctors and a nurse who work at the hospital, and a local teacher. It was held at a local guest house and was beautifully decorated with swathes of red and white material and fairy lights every where, much like a Western wedding. There was a head table where the birthday people would sit, and then rows of seats all facing the head table. As Wazungus we were characteristically early. I wore one of my two dresses I brought with me, and sat awaiting the start of the party. As people arrived it dawned on me that I needed to get a new dress! The ladies looked so amazing in their party dresses and head scarves! I was in awe, and have decided that when next I get a chance to buy some nice fabric I will get the local tailor to create something spectacular. Whether I will suit such fashions is something separate altogether, but even after losing weight, I have been blessed with aspects of an African’s woman’s body! Even so they may laugh me out of the party!
My colleague and friend Monica came with her husband, as did our neighbours and we proceeded to discuss who was married or related to whom, and I had to sit there for a full 10 minutes as the ladies discussed which man I should marry! It was thankfully decided that none were worthy of me! Yet my friends still proceeded to embarrass me when the hospital driver appeared to say hello. He was dressed in full Islamic prayer clothes, even though he is a Christian! On our second meeting, he had given me a musical card stating that he loved me. He had accompanied that with a rose with a small polar bear like animal attached. I was incredibly embarrassed, and could only mutter a thank you before I ran away! This guy tries to woo every white girl that comes to Nyangao, and I will not be the last!
I was more interested in the drink and food at this event! In Tanzania, you pay an admittance fee which includes your drinks and your food, and our rate was 15,000 Tsh. For about £8 or so we got 5 beers and a nice spread of chicken, plaintain, chips, salad, and samosas. It was very good, and although the beer was warm, I loved it! We continued to sit, eat and drink until the guests of honour arrived 2 hours later. They came in procession dressed in white and red matching suits. It was beautiful, but it was so much like a wedding that it was a little odd. They took their places at the head table and the festivities begun. The music started and the family were introduced. It was a very happy occasion, although the men looked painfully embarrassed by it all! We were all called up to congratulate them, and proceeded to do a shuffling conga around the courtyard and past the family and head tables saying ‘ongera’ (congratulations) and knocking our drinks together.
We sat back down, and a huge cake was brought out. They guests of honour rose one by one, and family members and friends were called and they fed each other pieces of the cake (again very reminiscent of a wedding reception). I was very tempted to go up just to get a cake fix, but I was able to prevent myself! This continued for a very long time, but it was lovely to watch it and see how happy the families were. It really brought home how important turning 50 is here. The nurse Mama Agnella nearly dies last year of kidney failure, but was saved by the hard work of the hospital. Also the teacher was diagnosed as HIV positive 10 years ago, and lost her husband and her son to AIDS. Yet here she was looking healthy, happy and beautiful. It was very poignant, and I was very proud even though I did not even know her.
After the cake fest, the music began in earnest. Initially people from the tribes of the birthday men and women were called up to dance. They were all from the same tribe, and so a huge number of people went to dance in the small space in front of the head table. The guests of honour sat watching and did not dance as I expected they would, but the men were beginning to smile more! Then to my horror I was dragged to the front and told to dance with Monica and her husband! The only Mzungu on the dance floor! I prayed that my years of dance training would help me not to stand out anymore than I already did. When you are surrounded by people who naturally have incredible rhythm, and you originate from a place where bad dancing to songs like ‘living on a prayer’ at discos is a given, it becomes very scary (even when you have had five beers!). However I soon relaxed, and Peter was a very good dance partner, protecting me from the hospital driver who was moving closer and closer with every second! After what seemed like hours but was about 5 minutes I went back to sit down, and was immediately congratulated on my moves by some people! Result!
Soon it was time for us to leave, and so I missed the gift ceremony, and could hear back at the house that the celebrations continued on until the very early morning. I had a wonderful time, and felt privileged to be invited to share such an important ceremony for people I hardly know. This is another example of the openness and generosity of the Tanzanians. I am definitely going to have a 30th birthday party like this one when I get back next year, so people get planning. I want a really big cake!
This came in the form of a joint 50th birthday party for two doctors and a nurse who work at the hospital, and a local teacher. It was held at a local guest house and was beautifully decorated with swathes of red and white material and fairy lights every where, much like a Western wedding. There was a head table where the birthday people would sit, and then rows of seats all facing the head table. As Wazungus we were characteristically early. I wore one of my two dresses I brought with me, and sat awaiting the start of the party. As people arrived it dawned on me that I needed to get a new dress! The ladies looked so amazing in their party dresses and head scarves! I was in awe, and have decided that when next I get a chance to buy some nice fabric I will get the local tailor to create something spectacular. Whether I will suit such fashions is something separate altogether, but even after losing weight, I have been blessed with aspects of an African’s woman’s body! Even so they may laugh me out of the party!
My colleague and friend Monica came with her husband, as did our neighbours and we proceeded to discuss who was married or related to whom, and I had to sit there for a full 10 minutes as the ladies discussed which man I should marry! It was thankfully decided that none were worthy of me! Yet my friends still proceeded to embarrass me when the hospital driver appeared to say hello. He was dressed in full Islamic prayer clothes, even though he is a Christian! On our second meeting, he had given me a musical card stating that he loved me. He had accompanied that with a rose with a small polar bear like animal attached. I was incredibly embarrassed, and could only mutter a thank you before I ran away! This guy tries to woo every white girl that comes to Nyangao, and I will not be the last!
I was more interested in the drink and food at this event! In Tanzania, you pay an admittance fee which includes your drinks and your food, and our rate was 15,000 Tsh. For about £8 or so we got 5 beers and a nice spread of chicken, plaintain, chips, salad, and samosas. It was very good, and although the beer was warm, I loved it! We continued to sit, eat and drink until the guests of honour arrived 2 hours later. They came in procession dressed in white and red matching suits. It was beautiful, but it was so much like a wedding that it was a little odd. They took their places at the head table and the festivities begun. The music started and the family were introduced. It was a very happy occasion, although the men looked painfully embarrassed by it all! We were all called up to congratulate them, and proceeded to do a shuffling conga around the courtyard and past the family and head tables saying ‘ongera’ (congratulations) and knocking our drinks together.
We sat back down, and a huge cake was brought out. They guests of honour rose one by one, and family members and friends were called and they fed each other pieces of the cake (again very reminiscent of a wedding reception). I was very tempted to go up just to get a cake fix, but I was able to prevent myself! This continued for a very long time, but it was lovely to watch it and see how happy the families were. It really brought home how important turning 50 is here. The nurse Mama Agnella nearly dies last year of kidney failure, but was saved by the hard work of the hospital. Also the teacher was diagnosed as HIV positive 10 years ago, and lost her husband and her son to AIDS. Yet here she was looking healthy, happy and beautiful. It was very poignant, and I was very proud even though I did not even know her.
After the cake fest, the music began in earnest. Initially people from the tribes of the birthday men and women were called up to dance. They were all from the same tribe, and so a huge number of people went to dance in the small space in front of the head table. The guests of honour sat watching and did not dance as I expected they would, but the men were beginning to smile more! Then to my horror I was dragged to the front and told to dance with Monica and her husband! The only Mzungu on the dance floor! I prayed that my years of dance training would help me not to stand out anymore than I already did. When you are surrounded by people who naturally have incredible rhythm, and you originate from a place where bad dancing to songs like ‘living on a prayer’ at discos is a given, it becomes very scary (even when you have had five beers!). However I soon relaxed, and Peter was a very good dance partner, protecting me from the hospital driver who was moving closer and closer with every second! After what seemed like hours but was about 5 minutes I went back to sit down, and was immediately congratulated on my moves by some people! Result!
Soon it was time for us to leave, and so I missed the gift ceremony, and could hear back at the house that the celebrations continued on until the very early morning. I had a wonderful time, and felt privileged to be invited to share such an important ceremony for people I hardly know. This is another example of the openness and generosity of the Tanzanians. I am definitely going to have a 30th birthday party like this one when I get back next year, so people get planning. I want a really big cake!
SCORPIO!
15.10.2010: SCORPIO!
Picture this…after an enjoyable night on the tiles in the village, I return tired but unable to sleep. I turn on another episode of the Gilmore Girls on my computer and settle down for an injection of small town American eccentricity. By the flicker of my laptop I spy a shape on the side of my mosquito net. I squint, trying to make out the shape of this hazy outline. I move, it moves. I freeze, it freezes. Horror dawns on me, I am unsure if horror is a component of a scorpion’s psyche. YES A SCORPION PEOPLE…INSIDE MY BED NET. I composed myself, and gently extricated myself from the bed, and quietly considered my options. Even in the Amazon I was never faced with such an event. So using my late-night, beer addled brain, I grabbed my mosquito repellent and sprayed him. Obviously the fact that he possesses nature’s rather well designed armour meant that this was not too successful. So I hit him with a book…20 times. It was like a scene out of Psycho, but with a book, and in a bed, and no human blood was spilt (yet). Then I picked him up with tweezers by his tail and flushed him down the loo. I crawled into bed after a thoroughly checking for his mates, and fell asleep.
Exactly a week later, in pretty much the same situation, I felt something crawling up the side of my neck. Now the odd small fly can get in through the bed net, so I absentmindedly reached up to swat, and felt an unsuspected hard crusty outer skin, and then a searing pain. I whipped my left hand away, and with it came original Mr. Scorpion’s angry comrade/family member still digging into my finger. I threw him to the end of the bed, where I think I stunned him for enough time that I could successfully leap out of bed and call my housemate Faith. She came with a container and a handy show-shine glove and shepherded Bert (I name all things that I am fearful of, I have named many spiders in my time) into his container.
My hand was throbbing, and as many of my sensory nerve fibres were damaged in my car accident, the feeling was incredibly strange. Faith and I consulted book and discussed whether I would die during the night. After a lengthy discussion, I decided that if it was my time to go, then a scorpion sting would be a very rock and roll reason. I checked my bed again, and with intense bravery ( I feel), crawled back into my scorpion infested bed to sleep. The next day I could not use my middle finger, or most of my hand. However, I was not dead (bonus), and my arm had not become gangrenous either (result). I decided to inspect for their hangout area, but I found nothing. So I treated my new net and since then I have had scorpion free nights. So the moral of this story is….don’t beat a scorpion to death unless you’re sure you can take on all his friends.
Picture this…after an enjoyable night on the tiles in the village, I return tired but unable to sleep. I turn on another episode of the Gilmore Girls on my computer and settle down for an injection of small town American eccentricity. By the flicker of my laptop I spy a shape on the side of my mosquito net. I squint, trying to make out the shape of this hazy outline. I move, it moves. I freeze, it freezes. Horror dawns on me, I am unsure if horror is a component of a scorpion’s psyche. YES A SCORPION PEOPLE…INSIDE MY BED NET. I composed myself, and gently extricated myself from the bed, and quietly considered my options. Even in the Amazon I was never faced with such an event. So using my late-night, beer addled brain, I grabbed my mosquito repellent and sprayed him. Obviously the fact that he possesses nature’s rather well designed armour meant that this was not too successful. So I hit him with a book…20 times. It was like a scene out of Psycho, but with a book, and in a bed, and no human blood was spilt (yet). Then I picked him up with tweezers by his tail and flushed him down the loo. I crawled into bed after a thoroughly checking for his mates, and fell asleep.
Exactly a week later, in pretty much the same situation, I felt something crawling up the side of my neck. Now the odd small fly can get in through the bed net, so I absentmindedly reached up to swat, and felt an unsuspected hard crusty outer skin, and then a searing pain. I whipped my left hand away, and with it came original Mr. Scorpion’s angry comrade/family member still digging into my finger. I threw him to the end of the bed, where I think I stunned him for enough time that I could successfully leap out of bed and call my housemate Faith. She came with a container and a handy show-shine glove and shepherded Bert (I name all things that I am fearful of, I have named many spiders in my time) into his container.
My hand was throbbing, and as many of my sensory nerve fibres were damaged in my car accident, the feeling was incredibly strange. Faith and I consulted book and discussed whether I would die during the night. After a lengthy discussion, I decided that if it was my time to go, then a scorpion sting would be a very rock and roll reason. I checked my bed again, and with intense bravery ( I feel), crawled back into my scorpion infested bed to sleep. The next day I could not use my middle finger, or most of my hand. However, I was not dead (bonus), and my arm had not become gangrenous either (result). I decided to inspect for their hangout area, but I found nothing. So I treated my new net and since then I have had scorpion free nights. So the moral of this story is….don’t beat a scorpion to death unless you’re sure you can take on all his friends.
Sunday, 10 October 2010
A typical working day you say? Nothing here is ever typical!
10th October 2010: A typical working day you say? Nothing here is ever typical!
So the time comes to share with you a typical working day in the life of moi. It is only now that I think I have enough knowledge of what I am actually doing that I can tell you! It begins thus:
06.30am- I awake remove my ear plugs, and doze listening to the bassy bongo flava music, and the families of patients cooking and talking. I again question why I am awake at such an ungodly hour, but then I realise that I do not have to switch lights on because it is dark outside, or walk over a mile in freezing rain; quite the contrary, the sun is shining, and it’s warm outside.
6.50am- I get up, get ready in about 5 minutes and have a cup of sweet tea. I greet my housemate Faith, who has probably been up since 4.45 am (!) and has already returned from an hours walk around the village. Although highly commendable, I am not going to be joining her.
07.25 am- We head across the makeshift football pitch/grazing area for cattle outside our house, to the hospital gates, (a 2 minute walk at most). It’s not a long walk, but the ubiquitous sand here in Nyangao makes it an effort. My feet are look like dirty street urchin’s feet by the time I make it to work! The families are all waiting outside the gates bringing water, food and other supplies in and out of the hospital. The patients normally arrive with two or three members of their families, and most of these members stay, prepare meals for them, help wash them, and keep them company. Whole family groups sometimes come and stay.
07.30 am- This is the official start of the morning meeting, however this is Africa, and so the actual start is fluid. I go first to the lab, and greet the person who has been on call over night and collect the daily report on the numbers and types of blood currently in stock
Oncall here includes many tests and procedures. Haemoglobin levels, creatinine and glucose in the blood are regularly tested, plus blood bank can be busy if emergency operations such as Caesarean sections occur overnight. If technically difficult tests are required like investigating cerebral spinal fluid, or night blood films for filiariasis, then the second on call is called. At present only two people in the lab are able to be that, as very few of the lab staff members are adequately trained. Monica my counter-part who is the Lab in charge is one, and Mr. Kamenya who at technician status is the most technically qualified member of staff. I luckily do not have to do on call, and I savour that, although they all have my number in case they would randomly need me for something.
There is a bed in the lab by my office, and they often sleep there if they are called out very late. It reminds me a little of the tiny room I had to sleep in when I was on call in Maidstone, except the lack of bedding and ensuite toilet/shower.
07.35 am – I sit down in the hospital meeting room and greet the medical teams that are required to attend morning meeting every day. This includes the surgical team, the obstetricians, general medicine, the doctor in charge who is also the dentist, a paediatrician, the Patron who is in charge of the nursing staff, Barbara the VSO pharmacist, Dr. Faith the HIV and AIDS coordinator, the radiographers and little old me. Phew. It sounds a lot of people, but not everyone always turns up.
Most of the clinical staff are made up of clinical officers. These have no tangible formal medical education, but have been to school to start their studies. The AMOs are more highly qualified, and there are only very few fully qualified doctors, the Polish surgeon and my housemate Dr. Faith being two.
The meeting is always held in English, which is very handy! We begin with a report on the admissions and on call events overnight. As I said before, mostly this entails emergency Caesarean sections. This report also reports any deaths which occurred overnight. This can vary greatly, i.e. from none to about five, but I have become aware that there are many more than that on occasion, and are unknown at the time to the reporting staff. I then report the number of bloods we have in the blood bank, i.e. which is normally very little. Barbara reports on the numbers of certain drugs that are low, or have run out, and on many occasions asks for clinical advice on how to proceed with such low stocks. Sometimes there is an answer, most of the time questions are greeted by silence. It can be hard to obtain answers from the staff here, as they are not accustomed to speaking out in public domains, even when they are used to a meeting every morning.
The last part of the meeting is a review of all the x-rays from the previous day. I have learnt a great deal from these sessions; how to see TB infiltration, how to see enlarged hearts, livers, and pneumonia. The most shocking though are the broken bones. The majority of operations here are reduction and internal/external fixation of broken bones. They are normally caused by car and motorcycle injuries. However, sometimes they are incidents of falling out of coconut trees, playing football, but sadly also beatings. There have been quite a few female and male patients that have come in with multiple fractures of arms due to domestic violence. It is a reality in any country all over the world, but it is always a distressing reality. Another unwelcome sight is the number of young children suffering from TB, and the number of end stage AIDS sufferers with a myriad of pneumonias, and other infections. Although from a medically trained eye it is fascinating and educational, it is also desperately sad.
08.00 am- Yep that meeting may look intense, but normally only lasts about 20 minutes. I then return to the lab and greet everyone in my best Kiswahili. I greet everyone individually, as to not to would be rude. The greetings can take some time, but I enjoy having a giggle with them all. Once a month we sit down to a lab meeting, and discuss any issues that the lab management team have alongside those of the lab staff. I am here partly to help improve quality control and health and safety in the laboratory, so at present the meetings are mostly to do with setting up and maintaining controls of tests, and infection control. The meetings are held in English first and then Monica will translate into Kiswahili. I am really happy that these meeting seem to be going so well. Unlike the doctors at morning meeting, the lab staff are not afraid to raise their point, or disagree with one I have raised.
I think this has improved due to an event that occurred a few weeks ago. As part of my remit to improve health and safety awareness in the lab, I tried to ensure that all lab coats were not taken home to be washed, but washed by laundry at the hospital. Everyone seemed happy at the suggestion and it was organised. However, on the day that washing was set to happen, no-one agreed to hand over the coats. I was away that day, and I found out when I returned. I spoke to a few of them, and they said that the washing machines did not clean the coats adequately, and that they smelt. It became obvious that this particular improvement would not be a success. I called a little meeting, and asked them to tell me from now on if they were not happy with something I proposed they were to tell me, and that we could work together to see how to tackle the disagreement. I may be here to educate and help change certain areas, but there is no point in me making changes if they will not be followed at all, or only whilst I am here. In the end I made a compromise, that they could take their coats home to wash, only if they were to take them off and wash their hands when drinking chai and eating! So far they have kept to that promise! Plus now they are not so backward at coming forward about proposals I put forward!
09.00 am – Anyway I digress. The morning is a time of cleaning and preparation in the lab, and so it gives me an opportunity to work with Monica in the office. I am also here to continue training Monica in computer skills, i.e spreadsheets, word processing, emailing and the computerised stock system created by Johanna my predecessor. Once a month we will do a full stock check of the lab, and update the stock system. From this we then decide what stock we need. This would be quite simple if the system ran as it should, but hey it never does. I won’t bore you with full details, but here are some points about buying here in Nyangao:
• First we go to the Medical Stores Department (MSD). The government are supposed to pay a certain amount of money into this wholesaler every year. Currently they have severely underpaid into our account. We also have an account here linked from donors to the hospital. One such donor is the Elizabeth Glazer Foundation. They have set up a free sexually transmitted infection programme, from which the lab are supposed to get the majority our supplies. However, for many months these important supplies have been unavailable for uncertain reasons. We are constantly in discussion with this foundation about our need for new reagents, but advancement is a very slow process. However, to push too hard here is to make things go even slower, so it can be a political nightmare! Therefore for the lab, a trip to MSD for us normally yields very little.
• Our next port of call is to ask other hospitals in the area for supplies. The regional hospital in Lindi which has close links to the District Medical Office, always seems to have a good supply of everything, and luckily we have a good relationship! That can tide us over for a few weeks, but we are constantly aware that our supplies will disappear!
• For other things not associated with the free programme, we buy from suppliers in Dar es Salaam, and Mr. John a mysterious man, who can you almost everything you need at a price of course! All in all though, I have learnt that to beg and borrow is the best bet.
10.30 am- CHAI TIME. The lab cleaners and some other staff sit at this time to eat and drink tea. I normally provide samosas that I buy from Michael in theatres! I can go to the main tea room in the hospital and eat and drink better food with the doctors, but I like to stay with these ladies in the lab, and I use this time to try and chat to them all in Kiswahili. This is the only food I will have until dinner, so I try and eat, but potatoes and cassava in chilli sauce is not my favourite thing!
11.00 am- It starts to become very busy in the lab now, as the numbers of patients waiting outside rises. Lab staff collect the specimens from inpatients in the wards, but outpatients come to lab personally, where their blood is taken by the staff, or they are given specimen pots to do their relevant business in. When I say specimen pots I actually mean old medicine bottles for urine, and small match boxes for stools! I have succeeded in ordering a three month supply of disposable plastic bottles to make sure that at least we have safe specimen containers for stool samples, but I am not sure how long we can afford them for!
The patients wait until they receive their results, sometimes they can stand or sit upright, but mostly they have to lie on the concrete floor outside. There is not a great deal of space for waiting in this hospital, and there are so many patients! It can be distressing to see at times, especially when it is a lone young women crumpled on the floor, but there is so little that can be done except make sure she has her results as quickly as possible, so she can be admitted or treated. The lab staff do trry to work very hard during the busiest times but often the waves of patients just keep coming. As yet I am not very helpful practically. I am hoping that I will be able to do some technical stuff soon, so I could assist them if required.
12.00 pm. I tend to be in the office most of the day, and I use the afternoon to continue updating and writing SOPs, training questions, or currently collating data for our donors and the Ministry of Health. This is a crazy and sometimes seemingly impossible task. No results are individually computerised. There is only one computer in the lab, and the ministry requires all results to be written in books that are then sent to the government. Therefore I am collecting data manually, which is slow and I think a waste of my time. So after this quarter I am going to figure out a way it can be done more quickly and efficiently. I am not sure how that will happen just yet…..
14.00 pm- On certain days when the number of units of blood is less than 15, I will order more from the Mtwara blood bank. This process involves us asking for blood in reference to current stock, and what we think we require, and sending an email of our request. The zonal blood bank then wait on average 4 days to send any blood to us, and it is often much less than we asked for. This is not the zonal blood banks fault. There is an obvious lack of safe donors available in Africa, and these tend to be secondary school children. When the school holidays are in full flow, the number of donors dries up, and therefore they have little blood to distribute. On these occasions we have the ability in our lab to allow family members to donate blood, and we test for the obvious blood infections. Yet, family members can be found to be positive for certain diseases, which mean problems for the patient, and consequently problems for the family members. When the blood is finally sent it is sent alone in a cool box on a public bus! It shocked me the first time, as I was sure someone would have stolen it, or it would have been damaged, but it arrives every time safe and sound.
15.30 pm This is the end of the working day for me, and often by this time I am pretty darn tired. It is not as crazy busy here as life at home, but the work is constant and sometimes intense! I am still trying to find out how to effectively start my objectives for sustainable capacity building here in the Nyangao maabara, but as you can see, my everyday work is rather full already. Yet I am getting there slowly! I say Jioni njema, to the lab staff, and all those I see on my walk home, and start thinking about what wondrous meal of tomatoes, peppers and onions I can create tonight and the cold bottle of Kilamanjaro beer that I have waiting in the fridge. Some working week habits never change!
So the time comes to share with you a typical working day in the life of moi. It is only now that I think I have enough knowledge of what I am actually doing that I can tell you! It begins thus:
06.30am- I awake remove my ear plugs, and doze listening to the bassy bongo flava music, and the families of patients cooking and talking. I again question why I am awake at such an ungodly hour, but then I realise that I do not have to switch lights on because it is dark outside, or walk over a mile in freezing rain; quite the contrary, the sun is shining, and it’s warm outside.
6.50am- I get up, get ready in about 5 minutes and have a cup of sweet tea. I greet my housemate Faith, who has probably been up since 4.45 am (!) and has already returned from an hours walk around the village. Although highly commendable, I am not going to be joining her.
07.25 am- We head across the makeshift football pitch/grazing area for cattle outside our house, to the hospital gates, (a 2 minute walk at most). It’s not a long walk, but the ubiquitous sand here in Nyangao makes it an effort. My feet are look like dirty street urchin’s feet by the time I make it to work! The families are all waiting outside the gates bringing water, food and other supplies in and out of the hospital. The patients normally arrive with two or three members of their families, and most of these members stay, prepare meals for them, help wash them, and keep them company. Whole family groups sometimes come and stay.
07.30 am- This is the official start of the morning meeting, however this is Africa, and so the actual start is fluid. I go first to the lab, and greet the person who has been on call over night and collect the daily report on the numbers and types of blood currently in stock
Oncall here includes many tests and procedures. Haemoglobin levels, creatinine and glucose in the blood are regularly tested, plus blood bank can be busy if emergency operations such as Caesarean sections occur overnight. If technically difficult tests are required like investigating cerebral spinal fluid, or night blood films for filiariasis, then the second on call is called. At present only two people in the lab are able to be that, as very few of the lab staff members are adequately trained. Monica my counter-part who is the Lab in charge is one, and Mr. Kamenya who at technician status is the most technically qualified member of staff. I luckily do not have to do on call, and I savour that, although they all have my number in case they would randomly need me for something.
There is a bed in the lab by my office, and they often sleep there if they are called out very late. It reminds me a little of the tiny room I had to sleep in when I was on call in Maidstone, except the lack of bedding and ensuite toilet/shower.
07.35 am – I sit down in the hospital meeting room and greet the medical teams that are required to attend morning meeting every day. This includes the surgical team, the obstetricians, general medicine, the doctor in charge who is also the dentist, a paediatrician, the Patron who is in charge of the nursing staff, Barbara the VSO pharmacist, Dr. Faith the HIV and AIDS coordinator, the radiographers and little old me. Phew. It sounds a lot of people, but not everyone always turns up.
Most of the clinical staff are made up of clinical officers. These have no tangible formal medical education, but have been to school to start their studies. The AMOs are more highly qualified, and there are only very few fully qualified doctors, the Polish surgeon and my housemate Dr. Faith being two.
The meeting is always held in English, which is very handy! We begin with a report on the admissions and on call events overnight. As I said before, mostly this entails emergency Caesarean sections. This report also reports any deaths which occurred overnight. This can vary greatly, i.e. from none to about five, but I have become aware that there are many more than that on occasion, and are unknown at the time to the reporting staff. I then report the number of bloods we have in the blood bank, i.e. which is normally very little. Barbara reports on the numbers of certain drugs that are low, or have run out, and on many occasions asks for clinical advice on how to proceed with such low stocks. Sometimes there is an answer, most of the time questions are greeted by silence. It can be hard to obtain answers from the staff here, as they are not accustomed to speaking out in public domains, even when they are used to a meeting every morning.
The last part of the meeting is a review of all the x-rays from the previous day. I have learnt a great deal from these sessions; how to see TB infiltration, how to see enlarged hearts, livers, and pneumonia. The most shocking though are the broken bones. The majority of operations here are reduction and internal/external fixation of broken bones. They are normally caused by car and motorcycle injuries. However, sometimes they are incidents of falling out of coconut trees, playing football, but sadly also beatings. There have been quite a few female and male patients that have come in with multiple fractures of arms due to domestic violence. It is a reality in any country all over the world, but it is always a distressing reality. Another unwelcome sight is the number of young children suffering from TB, and the number of end stage AIDS sufferers with a myriad of pneumonias, and other infections. Although from a medically trained eye it is fascinating and educational, it is also desperately sad.
08.00 am- Yep that meeting may look intense, but normally only lasts about 20 minutes. I then return to the lab and greet everyone in my best Kiswahili. I greet everyone individually, as to not to would be rude. The greetings can take some time, but I enjoy having a giggle with them all. Once a month we sit down to a lab meeting, and discuss any issues that the lab management team have alongside those of the lab staff. I am here partly to help improve quality control and health and safety in the laboratory, so at present the meetings are mostly to do with setting up and maintaining controls of tests, and infection control. The meetings are held in English first and then Monica will translate into Kiswahili. I am really happy that these meeting seem to be going so well. Unlike the doctors at morning meeting, the lab staff are not afraid to raise their point, or disagree with one I have raised.
I think this has improved due to an event that occurred a few weeks ago. As part of my remit to improve health and safety awareness in the lab, I tried to ensure that all lab coats were not taken home to be washed, but washed by laundry at the hospital. Everyone seemed happy at the suggestion and it was organised. However, on the day that washing was set to happen, no-one agreed to hand over the coats. I was away that day, and I found out when I returned. I spoke to a few of them, and they said that the washing machines did not clean the coats adequately, and that they smelt. It became obvious that this particular improvement would not be a success. I called a little meeting, and asked them to tell me from now on if they were not happy with something I proposed they were to tell me, and that we could work together to see how to tackle the disagreement. I may be here to educate and help change certain areas, but there is no point in me making changes if they will not be followed at all, or only whilst I am here. In the end I made a compromise, that they could take their coats home to wash, only if they were to take them off and wash their hands when drinking chai and eating! So far they have kept to that promise! Plus now they are not so backward at coming forward about proposals I put forward!
09.00 am – Anyway I digress. The morning is a time of cleaning and preparation in the lab, and so it gives me an opportunity to work with Monica in the office. I am also here to continue training Monica in computer skills, i.e spreadsheets, word processing, emailing and the computerised stock system created by Johanna my predecessor. Once a month we will do a full stock check of the lab, and update the stock system. From this we then decide what stock we need. This would be quite simple if the system ran as it should, but hey it never does. I won’t bore you with full details, but here are some points about buying here in Nyangao:
• First we go to the Medical Stores Department (MSD). The government are supposed to pay a certain amount of money into this wholesaler every year. Currently they have severely underpaid into our account. We also have an account here linked from donors to the hospital. One such donor is the Elizabeth Glazer Foundation. They have set up a free sexually transmitted infection programme, from which the lab are supposed to get the majority our supplies. However, for many months these important supplies have been unavailable for uncertain reasons. We are constantly in discussion with this foundation about our need for new reagents, but advancement is a very slow process. However, to push too hard here is to make things go even slower, so it can be a political nightmare! Therefore for the lab, a trip to MSD for us normally yields very little.
• Our next port of call is to ask other hospitals in the area for supplies. The regional hospital in Lindi which has close links to the District Medical Office, always seems to have a good supply of everything, and luckily we have a good relationship! That can tide us over for a few weeks, but we are constantly aware that our supplies will disappear!
• For other things not associated with the free programme, we buy from suppliers in Dar es Salaam, and Mr. John a mysterious man, who can you almost everything you need at a price of course! All in all though, I have learnt that to beg and borrow is the best bet.
10.30 am- CHAI TIME. The lab cleaners and some other staff sit at this time to eat and drink tea. I normally provide samosas that I buy from Michael in theatres! I can go to the main tea room in the hospital and eat and drink better food with the doctors, but I like to stay with these ladies in the lab, and I use this time to try and chat to them all in Kiswahili. This is the only food I will have until dinner, so I try and eat, but potatoes and cassava in chilli sauce is not my favourite thing!
11.00 am- It starts to become very busy in the lab now, as the numbers of patients waiting outside rises. Lab staff collect the specimens from inpatients in the wards, but outpatients come to lab personally, where their blood is taken by the staff, or they are given specimen pots to do their relevant business in. When I say specimen pots I actually mean old medicine bottles for urine, and small match boxes for stools! I have succeeded in ordering a three month supply of disposable plastic bottles to make sure that at least we have safe specimen containers for stool samples, but I am not sure how long we can afford them for!
The patients wait until they receive their results, sometimes they can stand or sit upright, but mostly they have to lie on the concrete floor outside. There is not a great deal of space for waiting in this hospital, and there are so many patients! It can be distressing to see at times, especially when it is a lone young women crumpled on the floor, but there is so little that can be done except make sure she has her results as quickly as possible, so she can be admitted or treated. The lab staff do trry to work very hard during the busiest times but often the waves of patients just keep coming. As yet I am not very helpful practically. I am hoping that I will be able to do some technical stuff soon, so I could assist them if required.
12.00 pm. I tend to be in the office most of the day, and I use the afternoon to continue updating and writing SOPs, training questions, or currently collating data for our donors and the Ministry of Health. This is a crazy and sometimes seemingly impossible task. No results are individually computerised. There is only one computer in the lab, and the ministry requires all results to be written in books that are then sent to the government. Therefore I am collecting data manually, which is slow and I think a waste of my time. So after this quarter I am going to figure out a way it can be done more quickly and efficiently. I am not sure how that will happen just yet…..
14.00 pm- On certain days when the number of units of blood is less than 15, I will order more from the Mtwara blood bank. This process involves us asking for blood in reference to current stock, and what we think we require, and sending an email of our request. The zonal blood bank then wait on average 4 days to send any blood to us, and it is often much less than we asked for. This is not the zonal blood banks fault. There is an obvious lack of safe donors available in Africa, and these tend to be secondary school children. When the school holidays are in full flow, the number of donors dries up, and therefore they have little blood to distribute. On these occasions we have the ability in our lab to allow family members to donate blood, and we test for the obvious blood infections. Yet, family members can be found to be positive for certain diseases, which mean problems for the patient, and consequently problems for the family members. When the blood is finally sent it is sent alone in a cool box on a public bus! It shocked me the first time, as I was sure someone would have stolen it, or it would have been damaged, but it arrives every time safe and sound.
15.30 pm This is the end of the working day for me, and often by this time I am pretty darn tired. It is not as crazy busy here as life at home, but the work is constant and sometimes intense! I am still trying to find out how to effectively start my objectives for sustainable capacity building here in the Nyangao maabara, but as you can see, my everyday work is rather full already. Yet I am getting there slowly! I say Jioni njema, to the lab staff, and all those I see on my walk home, and start thinking about what wondrous meal of tomatoes, peppers and onions I can create tonight and the cold bottle of Kilamanjaro beer that I have waiting in the fridge. Some working week habits never change!
Sunday, 19 September 2010
The last month in words
03.09.2010 Two happy anniversaries, and a cacophony of noise
Cockerels screeching before dawn and cockerels screaming after dawn. Oh yeah also at 4 o’clock…plus after dark. Bird calls of all varieties with a sprinkling of bat sounds. The hospital bell ringing at 6.00 am and at 6.30 am for good measure. Patient’s families cooking, sweeping, chatting, and on occasion, arguing at 04.30 am. Cows and goats having a chat sporadically. Children playing footie outside my house every evening. Babies crying, and families crying. Wind through the palms and bamboo. The doctor next door snoring in unison with my ascari (night guard). A two day wedding celebration with band parade. These are just a small spattering of the sounds I hear from my room within a day. Some I love, but others….well I can safely say that I love ear plugs! Especially now someone with a nifty set of speakers has decided that playing Celine Dion and Bongo flava at 06.30 am is the best decision ever! Glass is used sparingly here, and so windows are normally made up of metal mosquito netting , and slats of glass you can incline open. Yet it does allow the feeling of outdoor living!
My last few weeks have been all about getting used to my surroundings and them getting used to me. I am now known at the market, and have my favourite stall holders.I buy my take away beer from the local bars, and have got a good little deal going on with a man in theatres at the hospital who sells me samosas. I went on my third dalla dalla ride ever to Ndanda (again not on my own, I am working up to that!). It is an experience, even when only a short distance. You are crammed in much like when people try and break the record on how many people can you fit into a mini. Yet in this case, the mini moves!
Work was for the first month a time of trial and error. I asked many questions; some useful, others apparently not so much! People tried to help me, and sometimes I just became more confused, but now I seem to have developed a flow to some degree! Monica my colleague has returned, and now we are getting down to the nitty gritty of me being here, i.e. training, quality assurance, and a bit of health and safety. I will bore you with that another time, when I have something more to impress you with.
I take chai (tea) with the lab staff, and it gives me time to practice my Kiswahili! I am enjoying it, and feel like I can identify more and more words. It is just speaking that I find tricky! I have the greeting down, and the good byes, and I can say what I did at the weekend and last night, or will do next weekend and tomorrow, but it’s slow! They are patient with me, and are enjoying the fact that I want to learn; plus it gives them the opportunity to have a great laugh, moist of I at my expense but hey!
It has been my birthday since my last blog, and it ended up being a three day extravaganza! Tony and Barbara the other English VSO volunteers returned from England just in time. A lovely lady called Sherilyn (HELLO CHICK!) also arrived from London as an occupational therapist volunteer. She only stays for one month, but it is great to have her bubbly personality around. She joined the celebrations, along with the normal crowd. On my birthday, I was cooked dinner and had a lovely evening of chatting and relaxing. I had worked on my birthday, which is something I try hard to never ever do! But a well sang happy birthday from the lab staff made it worth it!
On the Friday, we went out on the town! In Nyangao this means chipsi mayai (chips in an omelette) or chipsi kuku (chicken and chips) washed down with beer! We sit in almost complete darkness at the bars as there are very few lights, but it makes the Milky Way even more beautiful. So it was a great night of chatting and stargazing. On the Saturday, I did something that I have never done before, I cooked a stew. Oh yeah baby, a stew! Now for those who know me well, cooking from scratch is not a usual occurrence for me, and as it would be a main course at my birthday party that night, thus I was very nervous indeed. The meat here is tough, ( I counted 42 chews per mouthful when I mistakenly fried it like a steak!) and I was doubly worried that it would be both tasteless and inedible. I apparently need not have feared, because it was a success, and we had a banquet, with everyone bringing a dish and some drinks. I was made a delicious birthday cake by Barbara, and I was spoilt with gifts of Parmesan cheese and chocolate all the way from England, plus a beautiful scarf from my housemate Faith!
The next day I went to Ndanda to swim in the lake within the woods. This exclusive pool is where the bruvers and sisters go to kick off their uniforms and have some down time….separately obviously! As it is deep, and I am not the bravest of swimmers, I tend to just go on a nature trail. It is part of the hydroelectricity network they have in Ndanda, and is part of the natural spring there, and all the bottled water from the area originates from this one place. It is a fascinating piece of natural and human engineering…apparently, but all I know is it tastes good. Here in Nyangao we can drink from the tap, as there is a closed water system. However, it tastes of the water you use to wash your mouth out when you have a sore throat or dental abscess (nice), so we take big bottles in Helga, Tony and Brabara’s trusty steed (car), and we nick their water! Not sure how we will continue that when T&B leave at the end of the year!
On my nature trail, I discovered that the ants rule Ndanda, and there are more about that I remember seeing even in the Ecuadorian rainforest! The butterflies and dragonflies are amazing, and there are some seriously funky white frogs that just like to endlessly sunbathe, and look petrified (as dead and old..not scared). There is also a Moniter lizard that likes to swim there on occasion, but as yet I have not spied him, but I have one in the roof at home in Nyangao, so I am not missing out.
During our trip to Ndanda, I also met another VSO volunteer called Hazel. She is a doctor who lives in Sheffield, but she was born and brought up in Maidstone! First I go all the way to Ecuador joined by a fellow Maidstonian (Hey Hans!), and now on my adventure here, I am joined by another one! I also met another VSO volunteer in Dar Es Salaam who grew up and lived in a street near me in Gillingham! It truly is a crazy small world!
13/09/2010 Moon gazing and Sun worshipping
So last week nearly everyone was either out looking for the moon, or listening to the radio to hear news about it. I was one of the many excitedly staring into the sky. I have not gone anymore crazy than I already am, but I was desperate for it to be a holiday! It has been Ramadan for the last month, and for Muslims and other villagers alike the arrival of the moon heralds the end of the fast, the beginning of the feast, and a day off work. For me it meant a three day weekend and a trip to the beach house at Mtwara.
The whole week, there had been changing opinions on when this holiday would begin. At morning meetings, the Tanzanian doctors would despair at us volunteers on our inability to deal with the spontaneity of it all! We had to plan for the holiday…that’s the Western way. Then we heard that Mecca had declared Friday to be the holiday, but Kenya were declaring that celebrations would begin on Saturday!! In the end however, we decided to give up and let thousands of years of tradition decide, and waited for the moon to arrive.
On Wednesday night no moon, so we went to work the next day, hopeful that tomorrow would be the day as Mecca had said. On Thursday night, it appeared that the sky would remain dark and moonless. However, at about 8.00pm a cheer rang out throughout the village, and the excited whoops of youngsters and children signalled the news that Eid-el-Fitr had arrived. The air was electric with excitement, and it was confirmed by our ascari, who still has to work over the holiday regardless. He still seemed excited and happy, and so I was interested to see how the holiday would affect the village, Muslim, Catholic, and Anglican alike. I however could not see the moon! Strange.
So the next day the call to prayer was loud and frequent, and four cows were butchered at the side of the road to celebrate the holiday. I slept in a whole 45 minutes, and then went to take the Dalla Dalla with Tony and Barbara to Mtwara. This journey can take up to 4 hours, and so I was dreading it a little, but I needed to understand where to get off when I venture out alone!
We only stood an hour, and the whole journey only took 2.5 hours. Speedy! Before I knew it, we were in the beach house, and the relaxation time could begin. The first thing was treat food shopping. Mama Tupe’s is a small shop run by a Polish lady, who sells some amazing things! This includes salami, sausages, and Heinz baked beans! Now to you that may seem dull, but to me that is the elixir of life! The others and I settled down to salami sandwiches, before we went to snorkel. Now my last trip here ended in a sprained ankle, so I was nervous. This time my flip-flops broke, and the jagged sea bed totally destroyed my feet! Maybe I will sort myself out for next time, and actually do it! Still this place is stunning, and it makes the rock pools in Cornwall and Reculver bay look like muddy puddles!
On returning to the beach house, we were met by hoardes of young children and teenagers dressed in their Sunday best walking along the beach and paddling. The beach quickly turned into a festival of people and colours, all laughing and enjoying themselves. We then decided to go for a swim. Sherilyn who was born in Zimbabwe and grew up in London, sat quietly on the beach, as all the children played around her. As soon as us white people went into the sea, the children started to play “try and touch the Mzungu”. This involves swimming as close as you can to a white/ sun burnt person before they see you. When the aforementioned person has you in their sights, you have to scream in delight and swim away as quickly as possible. After about 10 minutes of playing this, I went to sit by Sherilyn, and in seconds we were surrounded by children all checking out the Mzungu. Sherilyn laughed that of all the people she chose to hang with she chose the one that sticks out the most! I did not mind the audience, as children are sweet, and just like to watch how us White Europeans act. Yet sometimes it can feel like we are in a zoo! It suprises me sometimes, because there are many ex pats working in Mtwara, and so the children are exposed to Wazungus, but still they are fascinated and enthralled by the fair ones.
I also met a fantastic Tanzanian Father, who originally comes from Goa. He has been with the church for 45 years, and in the nicest possible way…it has provided him with wonderful generosity, friendliness, knowledge, and also a touch of pure madness! He was staying with his sister and nephew, and after returning from dinner, he ushered Sherilyn and me outside. He then produced a 3 litre bottle of Jaegermesiter, and a bottle of Afrika coco (Chocolate/coconut liqueur). He taught Sherilyn all about the wonders of Jaegermester, whilst discussing world politics. He also told us that his church had been destroyed by a falling Mango tree. Poor guy, but he knows how to drink away his sorrows! I do hope he finds a way to rebuild, so if your that way inclined please pray for him!
The weekend was a wonderful success, but we left Sherilyn at the beach house. This was a wrench for me, but good for her, as she got to spend her last week in Tanzania in paradise, with a crazy but delightful Catholic priest as company. I hope they don’t finish the bottle Jaeger!
Cockerels screeching before dawn and cockerels screaming after dawn. Oh yeah also at 4 o’clock…plus after dark. Bird calls of all varieties with a sprinkling of bat sounds. The hospital bell ringing at 6.00 am and at 6.30 am for good measure. Patient’s families cooking, sweeping, chatting, and on occasion, arguing at 04.30 am. Cows and goats having a chat sporadically. Children playing footie outside my house every evening. Babies crying, and families crying. Wind through the palms and bamboo. The doctor next door snoring in unison with my ascari (night guard). A two day wedding celebration with band parade. These are just a small spattering of the sounds I hear from my room within a day. Some I love, but others….well I can safely say that I love ear plugs! Especially now someone with a nifty set of speakers has decided that playing Celine Dion and Bongo flava at 06.30 am is the best decision ever! Glass is used sparingly here, and so windows are normally made up of metal mosquito netting , and slats of glass you can incline open. Yet it does allow the feeling of outdoor living!
My last few weeks have been all about getting used to my surroundings and them getting used to me. I am now known at the market, and have my favourite stall holders.I buy my take away beer from the local bars, and have got a good little deal going on with a man in theatres at the hospital who sells me samosas. I went on my third dalla dalla ride ever to Ndanda (again not on my own, I am working up to that!). It is an experience, even when only a short distance. You are crammed in much like when people try and break the record on how many people can you fit into a mini. Yet in this case, the mini moves!
Work was for the first month a time of trial and error. I asked many questions; some useful, others apparently not so much! People tried to help me, and sometimes I just became more confused, but now I seem to have developed a flow to some degree! Monica my colleague has returned, and now we are getting down to the nitty gritty of me being here, i.e. training, quality assurance, and a bit of health and safety. I will bore you with that another time, when I have something more to impress you with.
I take chai (tea) with the lab staff, and it gives me time to practice my Kiswahili! I am enjoying it, and feel like I can identify more and more words. It is just speaking that I find tricky! I have the greeting down, and the good byes, and I can say what I did at the weekend and last night, or will do next weekend and tomorrow, but it’s slow! They are patient with me, and are enjoying the fact that I want to learn; plus it gives them the opportunity to have a great laugh, moist of I at my expense but hey!
It has been my birthday since my last blog, and it ended up being a three day extravaganza! Tony and Barbara the other English VSO volunteers returned from England just in time. A lovely lady called Sherilyn (HELLO CHICK!) also arrived from London as an occupational therapist volunteer. She only stays for one month, but it is great to have her bubbly personality around. She joined the celebrations, along with the normal crowd. On my birthday, I was cooked dinner and had a lovely evening of chatting and relaxing. I had worked on my birthday, which is something I try hard to never ever do! But a well sang happy birthday from the lab staff made it worth it!
On the Friday, we went out on the town! In Nyangao this means chipsi mayai (chips in an omelette) or chipsi kuku (chicken and chips) washed down with beer! We sit in almost complete darkness at the bars as there are very few lights, but it makes the Milky Way even more beautiful. So it was a great night of chatting and stargazing. On the Saturday, I did something that I have never done before, I cooked a stew. Oh yeah baby, a stew! Now for those who know me well, cooking from scratch is not a usual occurrence for me, and as it would be a main course at my birthday party that night, thus I was very nervous indeed. The meat here is tough, ( I counted 42 chews per mouthful when I mistakenly fried it like a steak!) and I was doubly worried that it would be both tasteless and inedible. I apparently need not have feared, because it was a success, and we had a banquet, with everyone bringing a dish and some drinks. I was made a delicious birthday cake by Barbara, and I was spoilt with gifts of Parmesan cheese and chocolate all the way from England, plus a beautiful scarf from my housemate Faith!
The next day I went to Ndanda to swim in the lake within the woods. This exclusive pool is where the bruvers and sisters go to kick off their uniforms and have some down time….separately obviously! As it is deep, and I am not the bravest of swimmers, I tend to just go on a nature trail. It is part of the hydroelectricity network they have in Ndanda, and is part of the natural spring there, and all the bottled water from the area originates from this one place. It is a fascinating piece of natural and human engineering…apparently, but all I know is it tastes good. Here in Nyangao we can drink from the tap, as there is a closed water system. However, it tastes of the water you use to wash your mouth out when you have a sore throat or dental abscess (nice), so we take big bottles in Helga, Tony and Brabara’s trusty steed (car), and we nick their water! Not sure how we will continue that when T&B leave at the end of the year!
On my nature trail, I discovered that the ants rule Ndanda, and there are more about that I remember seeing even in the Ecuadorian rainforest! The butterflies and dragonflies are amazing, and there are some seriously funky white frogs that just like to endlessly sunbathe, and look petrified (as dead and old..not scared). There is also a Moniter lizard that likes to swim there on occasion, but as yet I have not spied him, but I have one in the roof at home in Nyangao, so I am not missing out.
During our trip to Ndanda, I also met another VSO volunteer called Hazel. She is a doctor who lives in Sheffield, but she was born and brought up in Maidstone! First I go all the way to Ecuador joined by a fellow Maidstonian (Hey Hans!), and now on my adventure here, I am joined by another one! I also met another VSO volunteer in Dar Es Salaam who grew up and lived in a street near me in Gillingham! It truly is a crazy small world!
13/09/2010 Moon gazing and Sun worshipping
So last week nearly everyone was either out looking for the moon, or listening to the radio to hear news about it. I was one of the many excitedly staring into the sky. I have not gone anymore crazy than I already am, but I was desperate for it to be a holiday! It has been Ramadan for the last month, and for Muslims and other villagers alike the arrival of the moon heralds the end of the fast, the beginning of the feast, and a day off work. For me it meant a three day weekend and a trip to the beach house at Mtwara.
The whole week, there had been changing opinions on when this holiday would begin. At morning meetings, the Tanzanian doctors would despair at us volunteers on our inability to deal with the spontaneity of it all! We had to plan for the holiday…that’s the Western way. Then we heard that Mecca had declared Friday to be the holiday, but Kenya were declaring that celebrations would begin on Saturday!! In the end however, we decided to give up and let thousands of years of tradition decide, and waited for the moon to arrive.
On Wednesday night no moon, so we went to work the next day, hopeful that tomorrow would be the day as Mecca had said. On Thursday night, it appeared that the sky would remain dark and moonless. However, at about 8.00pm a cheer rang out throughout the village, and the excited whoops of youngsters and children signalled the news that Eid-el-Fitr had arrived. The air was electric with excitement, and it was confirmed by our ascari, who still has to work over the holiday regardless. He still seemed excited and happy, and so I was interested to see how the holiday would affect the village, Muslim, Catholic, and Anglican alike. I however could not see the moon! Strange.
So the next day the call to prayer was loud and frequent, and four cows were butchered at the side of the road to celebrate the holiday. I slept in a whole 45 minutes, and then went to take the Dalla Dalla with Tony and Barbara to Mtwara. This journey can take up to 4 hours, and so I was dreading it a little, but I needed to understand where to get off when I venture out alone!
We only stood an hour, and the whole journey only took 2.5 hours. Speedy! Before I knew it, we were in the beach house, and the relaxation time could begin. The first thing was treat food shopping. Mama Tupe’s is a small shop run by a Polish lady, who sells some amazing things! This includes salami, sausages, and Heinz baked beans! Now to you that may seem dull, but to me that is the elixir of life! The others and I settled down to salami sandwiches, before we went to snorkel. Now my last trip here ended in a sprained ankle, so I was nervous. This time my flip-flops broke, and the jagged sea bed totally destroyed my feet! Maybe I will sort myself out for next time, and actually do it! Still this place is stunning, and it makes the rock pools in Cornwall and Reculver bay look like muddy puddles!
On returning to the beach house, we were met by hoardes of young children and teenagers dressed in their Sunday best walking along the beach and paddling. The beach quickly turned into a festival of people and colours, all laughing and enjoying themselves. We then decided to go for a swim. Sherilyn who was born in Zimbabwe and grew up in London, sat quietly on the beach, as all the children played around her. As soon as us white people went into the sea, the children started to play “try and touch the Mzungu”. This involves swimming as close as you can to a white/ sun burnt person before they see you. When the aforementioned person has you in their sights, you have to scream in delight and swim away as quickly as possible. After about 10 minutes of playing this, I went to sit by Sherilyn, and in seconds we were surrounded by children all checking out the Mzungu. Sherilyn laughed that of all the people she chose to hang with she chose the one that sticks out the most! I did not mind the audience, as children are sweet, and just like to watch how us White Europeans act. Yet sometimes it can feel like we are in a zoo! It suprises me sometimes, because there are many ex pats working in Mtwara, and so the children are exposed to Wazungus, but still they are fascinated and enthralled by the fair ones.
I also met a fantastic Tanzanian Father, who originally comes from Goa. He has been with the church for 45 years, and in the nicest possible way…it has provided him with wonderful generosity, friendliness, knowledge, and also a touch of pure madness! He was staying with his sister and nephew, and after returning from dinner, he ushered Sherilyn and me outside. He then produced a 3 litre bottle of Jaegermesiter, and a bottle of Afrika coco (Chocolate/coconut liqueur). He taught Sherilyn all about the wonders of Jaegermester, whilst discussing world politics. He also told us that his church had been destroyed by a falling Mango tree. Poor guy, but he knows how to drink away his sorrows! I do hope he finds a way to rebuild, so if your that way inclined please pray for him!
The weekend was a wonderful success, but we left Sherilyn at the beach house. This was a wrench for me, but good for her, as she got to spend her last week in Tanzania in paradise, with a crazy but delightful Catholic priest as company. I hope they don’t finish the bottle Jaeger!
Wednesday, 18 August 2010
16.08.10 Bullet point blitz
Yeah yeah I know, it has been over two weeks without a blog, but life got crazy busy! I actually think I may even have to resort to bullet points people…yes bullet points. Here goes…
• Work was going very well. I had the lovely Monica assisting me in learning everything. Then on the 2nd August she told me she needed an important operation and she would be admitted the next day! I was worried for her, and glad she was having the operation so quickly, but deep inside I was panicking! How was I ever going to be able to learn everything whilst dealing with the day to day work! Luckily the operation went well for my friend, and she is now recovering at home. Also the work is crazy busy, but the whole lab, and other hospital staff are helping me. I am managing to order blood, stock, and communicate with other hospitals. Yet I have so many questions, and I am wonder when their patience with the clueless one will run out.. and also when I will actually start doing something of help and worth here! Patience Zoe ! Learning protocol is tricky but I am enjoying it so far. In at the deep end as they say.
• I experienced my first earthquake here in Africa. I was lying in my bed and it began to vibrate. Stop tittering you lot! I thought it was a convoy of trucks on the main road a quarter of a mile away, but I was rectified in the morning by Dr. Yanke the Polish surgeon ( ironically I can’t spell his name) who discussed it at morning meeting. According to his reports, as he has a radio that can miraculously pick up English speaking stations! Lucky bugger. It was apparently 5.5 on the Richter scale, but a large number of miles below Lindi. It’s the only experience I’ll have of the earth moving for some time! Sorry mum and dad!
• I went on a beach weekend to Mtwara. The Diocese owns a lovely beach house which has a garden directly onto the unspoilt white sand beaches of the Indian Ocean. Oh how the church live eh! I could have laid there for two whole days straight, but the itinerary was too full! Day one included shopping for things not available at home (I bought myself some Heinz baked beans for about £1.70…not to barginous!), we visited the fish market too. This was a crazy and somewhat overwhelming experience, full of colours, smells and a great deal of bargaining by Tasneem, an English doctor who works in the hospital in Ndanda. I successfully returned with tuna, blue fish, and a fish that will rename nameless until I know it, but was big and red!
Brigite ( the German doctor I met in Masasi), Tasneem and I were also in charge on babysitting the children of Switz couple we were also staying with, whilst they went diving. Apparently the diving here is exceptional and one of the best places in the world. The instructor Jonny a guy from North Yorkshire (I think he was lying, he had no strange accent!) said that he had seen two Humpback whales in the bay the day before. If I was not so bloody scared of diving, I would definitely want take advantage of where I live. However, I also heard snorkelling was great, and so I planned to do that instead. Maybe a Humpback would pass by anyway!
So it was decided that we would take these two small children on a traditional but somewhat dilapidated Dhow boat with no life jackets across the rough water of the bay. I was nervous to say the least, and even though the boat leant heavily to one side we arrived to an idyllic private beach safely, and the children loved every minute (me not so much). Once on the beach we all swam in the crystal clear water and watched as the light changed the colours to a thousand types of blue and green. We hunted for shells, and built a sand castle car! Nice! We then returned in the Dhow, and I enjoyed it more on the return trip! It was a great weekend, and I met some amazing people, but it was a very expensive two days to say the least, on my volunteer budget anyway!
• Oh yes, I also sprained my ankle on way to the highly anticipated but now doomed snorkelling trip. Had a very swollen foot for a week. Still tender now, but doing ok!
• My surrogate mum and dad, Barbara and Tony had to leave for England unexpectedly for two weeks which was sad, but I met my new housemate Faith. She is a fellow VSO volunteer and the HIV and AIDS doctor here at Nyangao. I have a good history befriending Canadians, so I was happy to meet here.We get on great, and spend most of the time chatting away, and playing word games…. another rerun of the epic Scrabz marathon of Ecuador 2009 is on the cards. We also cooked the fish that shall remain nameless until I know it. This was bought at the Mtwara fish market (see above), and it was accompanied by coconut rice, from the coconuts in out garden and washed down with wine made by the nuns at Ndanda. Yummy!
I think that may be all for now?! Oh no wait… I found out that I work with five Manchester United fans, two Chelsea, one Liverpool, and only two other Arsenal supporters. They go to the doctor who lives next door to watch matches. I am working on getting invited to watch the games. Although a woman in the gang…I’m not so sure how successful I will be. They do like to tell me though that Arsenal drew with Liverpool, and by how many Man U won by i.e. they still revel in mocking me!
Sorry again for the layout! I had to do it this way to remember it all. It can be very difficult to find time, but it is strange how I always have time to watch my tv shows on my laptop. Hmmm???
Yeah yeah I know, it has been over two weeks without a blog, but life got crazy busy! I actually think I may even have to resort to bullet points people…yes bullet points. Here goes…
• Work was going very well. I had the lovely Monica assisting me in learning everything. Then on the 2nd August she told me she needed an important operation and she would be admitted the next day! I was worried for her, and glad she was having the operation so quickly, but deep inside I was panicking! How was I ever going to be able to learn everything whilst dealing with the day to day work! Luckily the operation went well for my friend, and she is now recovering at home. Also the work is crazy busy, but the whole lab, and other hospital staff are helping me. I am managing to order blood, stock, and communicate with other hospitals. Yet I have so many questions, and I am wonder when their patience with the clueless one will run out.. and also when I will actually start doing something of help and worth here! Patience Zoe ! Learning protocol is tricky but I am enjoying it so far. In at the deep end as they say.
• I experienced my first earthquake here in Africa. I was lying in my bed and it began to vibrate. Stop tittering you lot! I thought it was a convoy of trucks on the main road a quarter of a mile away, but I was rectified in the morning by Dr. Yanke the Polish surgeon ( ironically I can’t spell his name) who discussed it at morning meeting. According to his reports, as he has a radio that can miraculously pick up English speaking stations! Lucky bugger. It was apparently 5.5 on the Richter scale, but a large number of miles below Lindi. It’s the only experience I’ll have of the earth moving for some time! Sorry mum and dad!
• I went on a beach weekend to Mtwara. The Diocese owns a lovely beach house which has a garden directly onto the unspoilt white sand beaches of the Indian Ocean. Oh how the church live eh! I could have laid there for two whole days straight, but the itinerary was too full! Day one included shopping for things not available at home (I bought myself some Heinz baked beans for about £1.70…not to barginous!), we visited the fish market too. This was a crazy and somewhat overwhelming experience, full of colours, smells and a great deal of bargaining by Tasneem, an English doctor who works in the hospital in Ndanda. I successfully returned with tuna, blue fish, and a fish that will rename nameless until I know it, but was big and red!
Brigite ( the German doctor I met in Masasi), Tasneem and I were also in charge on babysitting the children of Switz couple we were also staying with, whilst they went diving. Apparently the diving here is exceptional and one of the best places in the world. The instructor Jonny a guy from North Yorkshire (I think he was lying, he had no strange accent!) said that he had seen two Humpback whales in the bay the day before. If I was not so bloody scared of diving, I would definitely want take advantage of where I live. However, I also heard snorkelling was great, and so I planned to do that instead. Maybe a Humpback would pass by anyway!
So it was decided that we would take these two small children on a traditional but somewhat dilapidated Dhow boat with no life jackets across the rough water of the bay. I was nervous to say the least, and even though the boat leant heavily to one side we arrived to an idyllic private beach safely, and the children loved every minute (me not so much). Once on the beach we all swam in the crystal clear water and watched as the light changed the colours to a thousand types of blue and green. We hunted for shells, and built a sand castle car! Nice! We then returned in the Dhow, and I enjoyed it more on the return trip! It was a great weekend, and I met some amazing people, but it was a very expensive two days to say the least, on my volunteer budget anyway!
• Oh yes, I also sprained my ankle on way to the highly anticipated but now doomed snorkelling trip. Had a very swollen foot for a week. Still tender now, but doing ok!
• My surrogate mum and dad, Barbara and Tony had to leave for England unexpectedly for two weeks which was sad, but I met my new housemate Faith. She is a fellow VSO volunteer and the HIV and AIDS doctor here at Nyangao. I have a good history befriending Canadians, so I was happy to meet here.We get on great, and spend most of the time chatting away, and playing word games…. another rerun of the epic Scrabz marathon of Ecuador 2009 is on the cards. We also cooked the fish that shall remain nameless until I know it. This was bought at the Mtwara fish market (see above), and it was accompanied by coconut rice, from the coconuts in out garden and washed down with wine made by the nuns at Ndanda. Yummy!
I think that may be all for now?! Oh no wait… I found out that I work with five Manchester United fans, two Chelsea, one Liverpool, and only two other Arsenal supporters. They go to the doctor who lives next door to watch matches. I am working on getting invited to watch the games. Although a woman in the gang…I’m not so sure how successful I will be. They do like to tell me though that Arsenal drew with Liverpool, and by how many Man U won by i.e. they still revel in mocking me!
Sorry again for the layout! I had to do it this way to remember it all. It can be very difficult to find time, but it is strange how I always have time to watch my tv shows on my laptop. Hmmm???
Tuesday, 10 August 2010
27/07/2010 Nyangao watch out, I’m a coming!
Last week my Kiswahili teacher Benji had told us of a tragic story of his journey to Lindi (my placement area) 20 years before. He had travelled on a bus, and due to rain and the state of the roads, the buses became stranded in the middle of nowhere. For twenty five days these passengers and bus crew had to survive on practically no food and water from muddy puddles. Tragically many of the children on the bus did not survive. When finally help reached them, Benji had to go straight to hospital to be treated for severe dehydration and sores in his throat. He was one of the lucky ones. This really puts in to perspective how times have changed in some respects here, and made me feel ashamed about worrying about such superficial and silly things in regards to me flying down to Mtwara, but despite my best efforts I still did. Silly Mzungu.
I awoke very early (alfajiri) to the call to prayer echoing around the hotel room. My heart leapt at the reminder that this was the beginning of my new life for the next 18 month, no more lazy days of unemployment, no more iphone, no more journeys on the 101 bus to meet friends in Drakes for drinkies, and no more sausages and cheese (the latter pained me the most!)
At 6 am or saa kumi na mbili kamilli asubuhi in Tanzanian time (the day starts 6 am here not midnight!) my taxi driver arrived on time (gasp) and I was off to my flight. I had a hundred worries… would I be searched, would I have to pay excess, and would the plane fall out the sky and crash to ground in a glorious fireball. I should have worried more about the first bit. Security here is surprisingly high for an internal flight, and I had to unpack my incredibly tightly packed bag. It always happens to me, I was even waiting for the infamous question I was once asked by an American jobs worth, “ Madam are you carrying viral culture or biological warfare in your bag?”…”Why yes sir I am, they were on sale in the Ecuadorian rainforest, I could not resist”, I obviously quipped in my head. The Tanzanian guy was a much nicer man, and kept repeating “pole sana” which is basically, I am very sorry!
After this I found my bags to be 14 kilos over the limit, which I expected. The lady behind the desk initially suspicious of this dishevelled, red faced Mzungu , asked for TSH 70,000. I was ready to pay all my wages at this point, as all I wanted to do was stop worrying about my baggage (I had left one and a half big bags back in Dar already). I used my excessive charm… or more likely pathetic pleading to secure an excess of only TSH 25,000. RESULT. Through another security area and then freedom! I was pleasantly surprised to find my flight left on time; the plane was modern and landed in Mtwara only an hour later. For about 5 minutes I cried inside as I could not find my bag, and thought the girl had dished out a different kind of penalty for putting such a heavy bag on her small plane. I was even more scared when the plane starting firing up engines to return with new passenger only 10 minutes after we landed. Yet, I was relieved to discover it was the first one out and under everyone else’s. STOP FRETTING YOU IDIOT, I screamed at myself (internally).
But then I saw them…two of my guardian angels in their chariot. Tony another VSO volunteer is a wonderful English gent, with a great sense of humour and a heart of gold. He was joined by his work colleague Deo, a lovely smiley Tanzanian guy. They whisked me away in the chariot, and through the beautiful and hot surroundings of Mtwara. I was led to places to buy essentials such as peanut butter, and corned beef. Tony bought sausages. I nearly died when I realised that they existed here in Mtwara.
I then had the pleasure in meeting another volunteer’s wife who had just come down from Uganda to live. Jackie is bright, bubbly and a delight to chat with. As a Ugandan she too is learning Kiswahili pole pole (slowly), but I feel she will be fluent before the month is out. All together we journeyed home, to the dulcet tones of African bongo music! The scenery is beautiful, with palms and other trees sweeping as far as the eye can see, with small mud hut villages spotted all along the tarmac road. In comparison to the north, the roads are fairly quiet and not so terrifyingly dangerous. Maybe it was more to do with the skills of my driver! Although he did admit to running over a flock of Hornbills (big turkey like birds) earlier that morning!
Before I knew it the vast convent and hospital sprung up out of the village of Nyangao. I was home.
I was shown to my house. I had seen it in pictures before, but I was still surprised by the size! It’s bigger than my house in England, and also has a lovely garden with a plethora of fruit trees and birdies to check out. I set up home in my room, which has a double bed (I have only had single beds for the past year). Small things eh! Yet no rest for the wicked, I was quickly whisked to meet all my colleagues in the hospital which is only a five minute walk away. The next hour was a blur of “Habari za leo”, “Nzuri”, “Karibu Nyangao”, and lots of “Asante sana”. I will let you translate those! I met my new lab colleagues, and feel very lucky! They are all lovely, and patient with my current lack of Kiswahili! Monica my compatriot is even more delightful and I am really looking forward to working with her for the next 18 months. Hopefully I can be as helpful to her as she has been to me!
After all this I was then collected by Tony in Helga his other chariot, a 20 year old green polo and whisked to his house. I was reunited with his lovely wife Barbara, a pharmacist at the hospital, whom I had the pleasure of meeting before in Dar. We chatted, drank beer, and guess what we had sausages and mash! Maybe one day I shall cheese again! I hope that I get a few more days like this one during my time here in Nyangao.
28.07.2010 First day nerves.
At 5.30am, my ascari (night guard), awakens in what I think he considers is a quiet fashion, but in reality is a symphony of coughs and moans. He sits outside the kitchen, not far from my bedroom, but it sometimes feels like he is in the room! So do the other people living across the football pitch outside my house. These are relatives of the patients in the hospital, whom stay in the family compound. Yet the sound of children happily playing is a great sound. Another sensory change here is the smell of burning. In England, if we smell that we either run around the house checking all appliances, or chastising a neighbour who dares to light a bonfire without telling us to close our windows. However, here people cook with charcoal stoves outside, and when done they leave them on the sand to smoulder. The acrid smell is now becoming normal, it reminds me of Reading festival and the fire queen that is Lucy Breeze, so good memories!
At 7.30am-7.45-8.00 am the morning meeting starts. All doctors, clinicians, Barbara, Monica, and I attend everyday to discuss the cases from yesterday and from overnight. It is very interesting, but although it is English, everyone speaks so softly and I think I may be a little deaf! After the meeting I join Monica in the lab. The lab is rather well equipped thanks to the hard work of Monica and Johanna the VSO volunteer I am replacing. There is organisation, and fragments of quality assurance, standard of operations, and maintenance of equipment, and I again realise how much I am going to learn from this experience. It frightens me a little, but it is exhilarating too.
I go through all the notes left by Johanna, and Monica explains how certain things work. I sit at the computer, slightly fretting about how I will be ever be able to get used to being in a position of seniority! I hope I don’t let anyone down! But Monica seems happy and confident in me so that’s reassuring! I then watched Thomas and Monica testing CD4s and practice my basically pathetic Kiswahili with them.
At 3.30pm it’s home time. I think about braving the market today, which again is only 5 minutes away, but I am exhausted. I go home, cook what is a rather pathetic stir-fry, and do some ironing. Yes I know, me doing ironing… but I’m senior now don’t you know!
29.07.2010 Pricking fingers and negative results.
I left the compound today! My day started with greetings a plenty, panic about where do I even begin, and an offer from Tony and Salvina that I could not refuse! They were going on HIV testing outreach to one of the surrounding villages. Tony had helped to start this up, and now it was possible that two trips occur per week. We arrived with John from the lab, Mary a nurse (Deo’s wife), and the formidable Salvina. We journeyed over crazy sand roads to this village, and set up in an empty building in the village. Announcers had been employed to inform people of our presence the day before, but no-one arrived for testing. I had never tested in this way before and I was slightly nervous about causing pain to people, even if it was just a pin prick! However, Tony was worse than me at it, so I felt better.
In the end we tested 76 people, half male and half female, with ages ranging from 14-63. All were negative, which was great to see, although Tony explained that often those with the riskiest lifestyles are too ashamed to go for testing, and the positive results often originate from the villages closer to the tarmac road. This is because the lorry drivers and travellers bring loose morals and infection on their way through. The road brings so much here, not all good.
I braved the market after work. It is actually rather small, and rather a friendly place for a tall blond haired Mzungu to wander. I met some nice stall holders, whom I’m sure were charging me way too much, but I was not going to argue over 20p today! I brought my wares home, and cooked a sumptuous feast of tomato pasta. I can cook I think, just not that well, but I was happy! I washed my clothes, and reconsidered again the opportunity to have my washing done every week for Tsh 17,000 a month. I am lazy, but at least I can admit it!
Last week my Kiswahili teacher Benji had told us of a tragic story of his journey to Lindi (my placement area) 20 years before. He had travelled on a bus, and due to rain and the state of the roads, the buses became stranded in the middle of nowhere. For twenty five days these passengers and bus crew had to survive on practically no food and water from muddy puddles. Tragically many of the children on the bus did not survive. When finally help reached them, Benji had to go straight to hospital to be treated for severe dehydration and sores in his throat. He was one of the lucky ones. This really puts in to perspective how times have changed in some respects here, and made me feel ashamed about worrying about such superficial and silly things in regards to me flying down to Mtwara, but despite my best efforts I still did. Silly Mzungu.
I awoke very early (alfajiri) to the call to prayer echoing around the hotel room. My heart leapt at the reminder that this was the beginning of my new life for the next 18 month, no more lazy days of unemployment, no more iphone, no more journeys on the 101 bus to meet friends in Drakes for drinkies, and no more sausages and cheese (the latter pained me the most!)
At 6 am or saa kumi na mbili kamilli asubuhi in Tanzanian time (the day starts 6 am here not midnight!) my taxi driver arrived on time (gasp) and I was off to my flight. I had a hundred worries… would I be searched, would I have to pay excess, and would the plane fall out the sky and crash to ground in a glorious fireball. I should have worried more about the first bit. Security here is surprisingly high for an internal flight, and I had to unpack my incredibly tightly packed bag. It always happens to me, I was even waiting for the infamous question I was once asked by an American jobs worth, “ Madam are you carrying viral culture or biological warfare in your bag?”…”Why yes sir I am, they were on sale in the Ecuadorian rainforest, I could not resist”, I obviously quipped in my head. The Tanzanian guy was a much nicer man, and kept repeating “pole sana” which is basically, I am very sorry!
After this I found my bags to be 14 kilos over the limit, which I expected. The lady behind the desk initially suspicious of this dishevelled, red faced Mzungu , asked for TSH 70,000. I was ready to pay all my wages at this point, as all I wanted to do was stop worrying about my baggage (I had left one and a half big bags back in Dar already). I used my excessive charm… or more likely pathetic pleading to secure an excess of only TSH 25,000. RESULT. Through another security area and then freedom! I was pleasantly surprised to find my flight left on time; the plane was modern and landed in Mtwara only an hour later. For about 5 minutes I cried inside as I could not find my bag, and thought the girl had dished out a different kind of penalty for putting such a heavy bag on her small plane. I was even more scared when the plane starting firing up engines to return with new passenger only 10 minutes after we landed. Yet, I was relieved to discover it was the first one out and under everyone else’s. STOP FRETTING YOU IDIOT, I screamed at myself (internally).
But then I saw them…two of my guardian angels in their chariot. Tony another VSO volunteer is a wonderful English gent, with a great sense of humour and a heart of gold. He was joined by his work colleague Deo, a lovely smiley Tanzanian guy. They whisked me away in the chariot, and through the beautiful and hot surroundings of Mtwara. I was led to places to buy essentials such as peanut butter, and corned beef. Tony bought sausages. I nearly died when I realised that they existed here in Mtwara.
I then had the pleasure in meeting another volunteer’s wife who had just come down from Uganda to live. Jackie is bright, bubbly and a delight to chat with. As a Ugandan she too is learning Kiswahili pole pole (slowly), but I feel she will be fluent before the month is out. All together we journeyed home, to the dulcet tones of African bongo music! The scenery is beautiful, with palms and other trees sweeping as far as the eye can see, with small mud hut villages spotted all along the tarmac road. In comparison to the north, the roads are fairly quiet and not so terrifyingly dangerous. Maybe it was more to do with the skills of my driver! Although he did admit to running over a flock of Hornbills (big turkey like birds) earlier that morning!
Before I knew it the vast convent and hospital sprung up out of the village of Nyangao. I was home.
I was shown to my house. I had seen it in pictures before, but I was still surprised by the size! It’s bigger than my house in England, and also has a lovely garden with a plethora of fruit trees and birdies to check out. I set up home in my room, which has a double bed (I have only had single beds for the past year). Small things eh! Yet no rest for the wicked, I was quickly whisked to meet all my colleagues in the hospital which is only a five minute walk away. The next hour was a blur of “Habari za leo”, “Nzuri”, “Karibu Nyangao”, and lots of “Asante sana”. I will let you translate those! I met my new lab colleagues, and feel very lucky! They are all lovely, and patient with my current lack of Kiswahili! Monica my compatriot is even more delightful and I am really looking forward to working with her for the next 18 months. Hopefully I can be as helpful to her as she has been to me!
After all this I was then collected by Tony in Helga his other chariot, a 20 year old green polo and whisked to his house. I was reunited with his lovely wife Barbara, a pharmacist at the hospital, whom I had the pleasure of meeting before in Dar. We chatted, drank beer, and guess what we had sausages and mash! Maybe one day I shall cheese again! I hope that I get a few more days like this one during my time here in Nyangao.
28.07.2010 First day nerves.
At 5.30am, my ascari (night guard), awakens in what I think he considers is a quiet fashion, but in reality is a symphony of coughs and moans. He sits outside the kitchen, not far from my bedroom, but it sometimes feels like he is in the room! So do the other people living across the football pitch outside my house. These are relatives of the patients in the hospital, whom stay in the family compound. Yet the sound of children happily playing is a great sound. Another sensory change here is the smell of burning. In England, if we smell that we either run around the house checking all appliances, or chastising a neighbour who dares to light a bonfire without telling us to close our windows. However, here people cook with charcoal stoves outside, and when done they leave them on the sand to smoulder. The acrid smell is now becoming normal, it reminds me of Reading festival and the fire queen that is Lucy Breeze, so good memories!
At 7.30am-7.45-8.00 am the morning meeting starts. All doctors, clinicians, Barbara, Monica, and I attend everyday to discuss the cases from yesterday and from overnight. It is very interesting, but although it is English, everyone speaks so softly and I think I may be a little deaf! After the meeting I join Monica in the lab. The lab is rather well equipped thanks to the hard work of Monica and Johanna the VSO volunteer I am replacing. There is organisation, and fragments of quality assurance, standard of operations, and maintenance of equipment, and I again realise how much I am going to learn from this experience. It frightens me a little, but it is exhilarating too.
I go through all the notes left by Johanna, and Monica explains how certain things work. I sit at the computer, slightly fretting about how I will be ever be able to get used to being in a position of seniority! I hope I don’t let anyone down! But Monica seems happy and confident in me so that’s reassuring! I then watched Thomas and Monica testing CD4s and practice my basically pathetic Kiswahili with them.
At 3.30pm it’s home time. I think about braving the market today, which again is only 5 minutes away, but I am exhausted. I go home, cook what is a rather pathetic stir-fry, and do some ironing. Yes I know, me doing ironing… but I’m senior now don’t you know!
29.07.2010 Pricking fingers and negative results.
I left the compound today! My day started with greetings a plenty, panic about where do I even begin, and an offer from Tony and Salvina that I could not refuse! They were going on HIV testing outreach to one of the surrounding villages. Tony had helped to start this up, and now it was possible that two trips occur per week. We arrived with John from the lab, Mary a nurse (Deo’s wife), and the formidable Salvina. We journeyed over crazy sand roads to this village, and set up in an empty building in the village. Announcers had been employed to inform people of our presence the day before, but no-one arrived for testing. I had never tested in this way before and I was slightly nervous about causing pain to people, even if it was just a pin prick! However, Tony was worse than me at it, so I felt better.
In the end we tested 76 people, half male and half female, with ages ranging from 14-63. All were negative, which was great to see, although Tony explained that often those with the riskiest lifestyles are too ashamed to go for testing, and the positive results often originate from the villages closer to the tarmac road. This is because the lorry drivers and travellers bring loose morals and infection on their way through. The road brings so much here, not all good.
I braved the market after work. It is actually rather small, and rather a friendly place for a tall blond haired Mzungu to wander. I met some nice stall holders, whom I’m sure were charging me way too much, but I was not going to argue over 20p today! I brought my wares home, and cooked a sumptuous feast of tomato pasta. I can cook I think, just not that well, but I was happy! I washed my clothes, and reconsidered again the opportunity to have my washing done every week for Tsh 17,000 a month. I am lazy, but at least I can admit it!
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