Medical Adventures in Africa and Canada

Photos: My hand

drfrenchie — Thu, 5 Nov 2015 14:12:00 GMT

When a cardiologist examines your hand

drfrenchie — Thu, 5 Nov 2015 13:54:00 GMT

“All will be ok” he said with such confidence. “Your hand, it’s not badly damaged”.

At first I believed him, as it seemed like the best thing to do at the time. After all, what’s wrong with having just a little bit of hope when you’re lying in an African hospital, far from home, with no money, you’re in shock from all the blood loss but decide that accepting blood products would be far too risky, and you’re about to have your hand sutured up without any form of pain relief. Clearly hearts, and not hands were his area of expertise, but I certainly wasn’t about to argue his clinical judgment. His name was Dr David. In the midst of all the chaos I never actually got his surname.

When I left Africa on Sunday 27^th September, two days after my incident, my right hand and left wrist were both heavily bandaged. Needless to say I couldn’t do anything for myself. Although I could use my left hand, I couldn’t carry any weight, and my right hand was, and still is completely useless. So, as you can imagine, my flight to Hawaii, via Ethiopia, Dublin and Los Angeles was just a little bit challenging. I couldn’t fill out any paperwork, couldn’t even do the seatbelt up on the aeroplane, and when I arrived in LAX it took 4 hours to clear customs because they insisted on examining every item of clothing in my bag without offering any assistance at all. The airline though was superb and I had my own air hostess to help me with everything, as well as an entire row of seats so I could at least get some sleep in between taking high doses of pain medication and attempting to eat like a 1 year old using a spoon for the first time.

Hawaii was amazing, although I’m sure at times Reuben got a little tired of having to wash my hair, cut up my food and hear about how painful my hand was. I was frustrated that I couldn’t go surfing, snorkelling or do any of the activities I really wanted to, but I was determined to not let my situation get in the way of a nice holiday. A week down the track and my hand was still extremely swollen and painful, so I thought it was probably a good idea to get it properly assessed when I arrived in Canada. Fortunately, as I was starting a placement at Vancouver General Hospital in the second week I was put in contact with an Emergency doctor, who upon assessing my hand decided I should probably get it check over by the Plastic Surgeons. At this stage I couldn’t move my thumb or index finger, the swelling was still very evident and the pain was only just being kept at bay with strong medication every 4-6 hours. The Emergency doctor made a phone call to a fellow colleague, who just happens to be one of the best hand plastic surgeons in the Canada. Not expecting anything to happen until the following week I started planning my weekend. The next day was Saturday, the same day that the All Blacks were playing France in the quarter final of the RWC. Not a game I wanted to miss. As I was heading to the pub at lunchtime to watch the game I received a phone call from the hospital asking if I could come in – so after explaining where I was heading they said come by after the game, which I did.

Over the next 5 hours I had my hand poked, prodded and eye-balled by four different doctors, all with varying looks of horror on their faces as I repeated my story to them. “A machete did this?” they all said, and before long I became the talking point of the entire emergency department. While waiting for my x-ray results to come back, they indicated to me I would need surgery as the extent to which my tendons were damaged was not something that could heal by itself. A surgical consent form was filled in and signed, and I started psyching myself up for what I was being told. Just as I was running over everything in my head, I looked over and saw the faces of all the plastic surgeons drop, and my consent form was swiftly torn up and thrown in the bin. What possibly could be wrong? As it turned out, not only did I have severed tendons to my thumb and index finger (five in total), radial nerve and muscle damage, I had been walking around with a fracture to the base of my thumb for the past 3 weeks. That fracture alone complicated things to the point where the surgeon said to me “we need to operate tomorrow, we’ll do our best to fix what we can, but until we open your hand up and have a good explore around we can’t make any promises as to your prognosis, but you need to be prepared that it might not be great”.

While it was nice to have hope at the start, the horror of this attack was starting to really take its toll. What would this mean for my medical career? Would I ever get full use of my hand back? I was gutted beyond words, but there wasn’t anything I could do about it other than pick myself up and prepare for the next phase.

The following day, two of the best hand surgeons in Canada spent two and a half hours delicately repairing my hand. I really couldn’t have asked to be in better hands (excuse the pun) and knowing they did the best possible job they could, and have given me the best possible chance of gaining most of my hand function back, is just incredible. I’m now starting a very long road to recovery, which will involve extensive hand physiotherapy for many months to come. My rehabilitation has already begun in Vancouver, and my goal is to be able to eat Christmas dinner with both a knife and a fork. I’m currently wearing a splint that completely immobilises my thumb as any movement at all could undo the repair work. My index finger has gained 3mm movement in 10 days, so I only have about 77 more mm to go. While I long for the day when I’ll be able to use both hands again, each day brings with it a little bit of progress, be it less pain or better control of my left hand for eating/writing. I’ll most definitely be ambidextrous by the end of all of this so I guess that’s an added bonus! And as for Vancouver – I can’t cycle around Stanley Park, but I did manage to hike to the top of Grouse Mountain last weekend in the snow and saw a couple of gorgeous Grizzly Bears (orphaned as cubs and being cared for by a vet and park rangers) who were about to go into hibernation for the winter. Overall, I’d say life isn’t too bad!

Final reflections of Tanzania

drfrenchie — Mon, 2 Nov 2015 14:55:00 GMT

I began writing this blog entry about 5 days before I left Tanzania, not knowing of course what was to sadly happen to me on my second to last day. While my lasting memories of Tanzania are nothing more than my vicious attack, I want to remind myself that Tanzania is a country I grew very fond of and over 6 weeks I met some amazing people, and experienced things that have changed me forever (in a good way).

Here are some final reflections of a country that I will remain close to my heart.

By far the most difficult thing I had to adjust in Tanzania was the concept of African time. In Tanzania, it seems time is not a precious commodity, but instead something that seems never-ending. People spend their days just mooching about. Tardiness is something the Tanzanians have mastered. Whether it be meeting friends in town, waiting for food to arrive at a restaurant, or how they wander down the street, pole pole (slower than slow) is certainly the common theme. If someone says they’ll be there in 5 minutes, forget it – you’ll still be waiting 3 hours later. Don’t ever arrive at a restaurant hungry, because by the time you get your food you’ll have eaten the chair you’re sitting on. And don’t ever expect to arrive at a destination at the time it should take. Always add at least an hour or more on to any journey, even if it is only a 15 minute walk down the street! I honestly think the giant tortoises on Prison Island moved faster than some people I’ve encountered in Arusha.

But through all the frustration and times when I’ve really felt like screaming at some of these people, it has taught me a thing or two about how I live my life. These people aren’t ever stressed out about being late or how long it takes to get absolutely nothing done – they’re some of the happiest people I have ever come across. So if I take nothing else away from Africa, I’ll at least learn to try and not be in such a hurry, and live in the moment.

Nothing ever prepared me for what I was to witness at St Elizabeth Hospital, but I have grown so much as a person through every experience and patient I was so privileged to meet and help treat. I will never forget my mornings spent on ward rounds, and afternoons in outpatient clinics, with a group of doctors and nurses that do such a tremendous job with so little. Resources are more basic than you could ever imagine, machines more outdated than me, and drugs so limited in both their supply and type. Yet, by what can only be described as a facility so primitive and outdated it’s like stepping into a time warp, stems a hospital filled with passionate staff and the most gracious patients I will ever encounter in my medical career. Sharing a bed with 3 other patients doesn’t faze these people. They are just grateful to receive any care at all. The level of knowledge taught to medical students in Tanzania is nothing more than a reflection of the medicine that is practised - it is simple but for the most part effective. Simple in terms of how a person is diagnosed, and simple in the treatment they eventually receive. I have witnessed more cases of HIV, tuberculosis, malaria, witch medicine, surgery with ketamine as the only anaesthetic agent offered, female genital mutilation, child birth and all its complications, wound debridement, dysentery, pneumonia, malnourishment, renal failure, anaemia, and death than I ever thought possible in 6 short weeks. I have at times felt completely out of my depth, and in despair at not being able to do anything for these patients. And I walk away minus one set of scrubs (I gifted them my pair so they at least have one matching set in their cupboard) and so extremely humbled by each and every person I have met along the way. I will never forget St Elizabeth Hospital, what it has taught me about medicine and being a doctor, and what it means to be a foreigner in an African hospital. You cannot change the world, but you most certainly can help change the lives of a handful of people and if nothing else I hope I have at least achieved that!

If having daily cold showers from a bucket, no electricity for 20 hours a day, being pursued by mosquitoes day and night despite lathering one’s self in insect repellent so strong it would deter even the most hardy person, being coated in a layer of dust so thick you could be mistaken for a local, eating the most awful peanut butter on stale white bread for breakfast every morning, or being crammed into a dala dala so tight you can’t feel your backside after 5 minutes is your idea of fun then look no further than Tanzania! Because my life for 6 weeks had been exactly that. And I wouldn’t have wanted to change it for the world. Ok, maybe a hot shower once a week would have been nice. But in all honesty, what I have experienced is nothing short of hilarious at best, and humiliating at worst. The constant barrage of unnecessary comments and stares from men on the street, made bearable by the hospitality of my incredible host family is what made my time in Tanzania so fascinating. The contrasts were at times incomprehensible. Snippets of Western civilisation emerging from the dust-laden tin shacks, as people attempt to adapt to the ever-changing environment that surrounds them. Advances in technology have at times been more of a hindrance than a benefit. People are expected to adapt to such changes, much like leaping from the abacus to the computer overnight without first learning their times tables. It is simply not feasible. The Tanzanians continue to tolerate corruption and bribery as though it is a normal part of living. Money buys everything in this country, including your way out of a roadside encounter with a police officer. I will not miss the chaos that is life in Tanzania, and I will most certainly not miss the absence of even the most basic amenities of life that I am so accustomed to and enjoy without even thinking about. But I will miss the beautiful countryside, the culture and the simplicity that life in this country has taught me.

A day I will never forget

drfrenchie — Mon, 2 Nov 2015 14:54:00 GMT

While many of you already know, because you’re on Facebook or know my mum, there are probably a few of you that aren’t aware of the events of September 25^th, a day I’ll never forget. I want to share with you details of that day, but please be warned that what I am about to write in the next few paragraphs isn’t pleasant. It has taken me over a month to pluck up the courage to even write this blog entry. That, and the fact my hand has been out of action for what is now entering the sixth week. So, for those that wish to continue reading, and those that don’t, thank you so very much for all of your support and love that I received over this past month. It has at times brought me to tears and I honestly don’t know how I would have kept going without all of the positive messages.

Friday September 25^th began like any other day in Arusha. I walked to St Elizabeth Hospital to drop of some supplies I had brought over with me, said my farewells to all of the wonderful staff, and headed to my local spot for an early lunch. I then took the Dala dala to the local Maasai art and crafts market, about a 1km walk from the city centre, to buy some gifts and souvenirs. It was about midday. I spent about an hour bartering my way through the market, picking up some wonderful gifts, including a scarf, African oil paintings, wooden animals, jewellery, and a few other trinkets that every visitor to Africa seems to acquire. When I left the market I remember having an inner conflict with myself. Do I turn left and head up the road for an ice cream, or do I go right and start making my way back home? I chose to turn right as I had a few things to get done that day and also needed to start packing my bag. A decision I would learn to regret. The road was busy, full of locals walking or travelling via Dala dala or Piki piki. It was 1pm and I was in a fantastic mood, almost skipping along the road, when from out of nowhere two men approached me from behind. Before I knew it I was on the ground, face-first, being kicked, punched and beaten to a pulp. About 30 seconds later I caught out of the corner of my eye, a third man approach from across the road, yelling “get the bag”. At this point I knew I was being mugged, and was more than happy to give them my bag. If it meant the beating would stop they could have my pink backpack containing my wallet, credit cards, money, iPhone, camera, gifts and clothes. After all, these are all replaceable. My life isn’t. As I struggled to get my backpack off my back (due to the constant kicking and punches being thrown at my helpless self), the third man pulled out a machete. The blade was about a foot long and I knew he meant business. With a couple of swift swings in the direction of my back, the straps of my bag were slashed and the two men who at this stage had inflicted bruises to most of my body, ran off with my blood-covered bag. The terror though was far from over, and as it transpired was only the beginning of what was a vicious and completely terrifying attack. The machete-wielding man wanted more, but I had no more to offer. Sadly, these men will not stop at anything and are prepared to kill their victims for the sake of a few material items. On this day, this man was prepared to take my life. I was essentially helpless. Me against a man with a foot-long machete. My only hope was to roll up in a ball and hope like hell he would give up before stabbing me in the chest or abdomen. It seemed to work, as for the next minute or so he swung his blade back in forth in a frenzy before running off into a nearby field. The shock was starting to settle in and at this point I was still unaware of the significant injuries I had sustained to my right hand. I don’t remember a great deal about the next few minutes, but somehow I was plucked up off the road, where I had been lying in a large pool of blood. I started screaming hysterically, as onlookers stood dazed and confused at the events of the last 5 minutes. I looked down at my hands and saw that my right hand had been sliced down to the bone in multiple places, the worst being across my palm and the base of my thumb. My left wrist has also been cut where my watch once was. It too had been stolen. My clothes were torn to shreds and I was covered from head-to-toe in blood. My legs were scratched and my entire body felt like I’d been hit by a bus. Not that I know what that actually feels like but I can imagine.

Almost instantly a man appeared on a motorbike and told me to get on the back so he could get me to the police. While a lovely gesture, the police weren’t my top priority at this point. I knew I needed to get to a hospital and time wasn’t on my side. I rode about 200 metres up the road on the back of his motorbike. Don’t ask how I held on because clearly it wasn’t possible in my current state. As we approached a roundabout he hailed down 4 police officers who were driving in the opposite direction, and swiftly asked me to get off his motorbike as the police could now help me. It was at this point I was getting more and more hysterical as everyone I spoke to just couldn’t understand my need to seek immediate medical attention. Fortunately the first of my guardian angels that day appeared from nowhere. Two men jumped out their car and said they would drive me to the hospital. I didn’t hesitate. These two men, one of whom is named Gideon Mollel, were truly incredible. I remember the drive to the hospital clearly, not because it was fast and furious, but because I recall the feeling of relief at finally being on my way to a hospital where I could get my hand attended to. Arriving at the hospital is a blur. I was the only foreigner in the hospital, and as I learned later I had an armed guard outside my room from the minute I arrived. Five doctors and three nurses arrived in quick succession to the treatment room where I lay, all in complete disbelief upon hearing what had happened to me. My two guardian angels, Gideon and his friend sat outside for the entire time, not wanting to leave until they knew I was safe. It is a strange situation to be in – in a hospital in Tanzania, with eight sets of eyes looking down on you, all speaking Swahili, and not doing a great deal other than telling me to stop crying as all will be ok. All would be ok, but at the time I was in a state of shock, had no way of contacting anybody and was losing blood faster than I had ever experienced. The pain was also starting to become more apparent by the minute. I knew I had to control my emotions, even just for a short time so that I could be sure I what treatment I was receiving. Interestingly none of the medical staff introduced themselves until I told them my name and asked for theirs. By this stage I’d been at the hospital a good 30 minutes and was still bleeding! The most senior doctor present was a cardiologist so it was deemed his responsibility to treat me. He assured me my hand wasn’t too badly damaged and that he would suture me up and all would be ok. He did however want me to stay in hospital overnight, something I was most definitely NOT keen on doing. The bed had no blanket or pillow and I was more terrified than you could ever imagine. He proceeded to get the suture kit out, which remained sterile until a cleaner came in half way through the ordeal and threw a dirty cloth over the trolley. I also had to ask the doctor to put gloves on, and for some local anaesthetic, which he kindly administered after he’d already done about 20 sutures! Needless to say, the whole experience was quite different to how I’d treated hand injuries in the Emergency department of Wellington hospital during my ED placement earlier this year. I asked to be given some IV antibiotics too – the broadest spectrum they had, and at the highest tolerated dose. That too was an oversight, and I hate to think what happens to other volunteers in this situation who don’t have the same medical knowledge me.

After I had been sutured up, and was given some pain relief in the form of IM (intramuscular) pethidine (which did absolutely NOTHING I might add), I was whisked off to another room where I was kept under close observation. One of the doctors very kindly bought me some lunch – chicken and rice and a bottle of Sprite from what I can remember. I only consumed about two mouthfuls as my appetite was non-existent. I desperately wanted to get in touch with my good friend, Aenea, a local Tanzanian who has been so wonderful to me I will never be able to repay him. Fortunately Aenea has a website so I knew if I could get access to the internet, I could find his number and get in contact. Another doctor managed to find the website, called him and I was able to speak to him, told him what had happened and where I was. He was an hour away so arranged to send a friend of his to visit me and make sure all was ok. Prior to arriving he drove to my host family’s house to inform my host mum, collected my host sister and drove to the hospital. Yet another incredible human being that I am so fortunate to have in my life! By this stage my hysteria was subsiding and I was beginning to feel a little more in control of the situation. The only remaining task was to get in touch with my family and partner, Reuben. I was able to skype mum on Aenea’s phone. It was 3am on Saturday morning in NZ, but as predicted mum had her iPad next to her bed and on the third attempt at calling she answered. I broke the news by first assuring her I was ok, then informed her that my passport hadn’t been stolen, and then told her what had just happened. Probably a wise order, otherwise I’m not sure if she would have heard the remainder of what I had to tell her had I just gone straight in with the Ï’ve been attacked by three men and a machete and had all my stuff stolen”line. Mum was then tasked with informing the rest of the family, including Reuben who was in Hawaii at an Underwater Hockey Tournament and not easily accessible.

After ten hours in the hospital, and a second dose of IV antibiotics I was discharged back home with instructions to return at 7am the next morning for dressing changes. I was more than happy with that plan as staying overnight was not going to be an option unless absolutely necessary. We stopped by the police station to file a report and at around midnight I finally arrived back home to the open arms of my entire host family. My host mum bathed me and prepared some food before I retired to bed, but the tears continued to flow throughout the night. Every attempt to close my eyes created nightmares and I lay there completely terrified, even though I knew I was now safe.

The following two days were spent mostly at the police station and the hospital, and on Sunday 27^th September I departed Arusha nursing two very sore hands, an aching, bruised and battered body and psychological pain I completely underestimated. I left Tanzania without the usual souvenirs most would have stashed away in their suitcase, but instead with a permanent reminder in the form of some rather impressive scars.

But, I will be back – I just don’t know when.

Photos: Arusha Snake Park

drfrenchie — Mon, 14 Sep 2015 19:05:00 GMT

Photos: Dar es Salaam and Zanzibar

drfrenchie — Sat, 12 Sep 2015 17:35:00 GMT

Dar es Salaam and Zanzibar

drfrenchie — Sat, 12 Sep 2015 17:32:00 GMT

My recent trip to Dar es Salaam and Zanzibar was simply amazing. It had been 3 very long weeks since I had seen the ocean, and I was starting to feel a bit like a land crab. I decided I would tackle the bus to get me to Dar, but given that the journey by road is at least 10 hours, flying home was going to be the only sensible option. Nonetheless it was great to see some of the beautiful Tanzanian countryside, even if it meant getting a rather sore bottom in the process. The journey started at 6am from Arusha, and didn’t end until 8pm when I finally made it to my hotel. I was sure the website said it would take only 10 hours, but clearly this is Africa so you need to add at least another 3-4 hours on to that, plus take into account the traffic in Dar es Salaam which is nothing less than complete and utter chaos. A city of 6 million with infrastructure so poor it can barely cope with 1 million people is always going to be recipe for disaster, and I, like everyone else in Dar at rush hour on Friday, found myself sat in one of the biggest traffic jams I have ever witnessed. But after what became a journey that I thought would never end, a hot shower and a very comfortable bed awaited me at my hotel in the middle of Kariakoo, the central suburb of Dar, most famous for its local market. I spent one day in Dar as I thought it would be good to see part of the city considering I had made such an effort to get there. But, like any other big city, once you’ve been to one you’ve been to them all. Dar es Salaam is dirty and smelly, and the people I found to be far more aggressive than anybody I had encountered in Arusha. I witnessed two guys having a heated argument about football which ended in one guy threatening to kill the other one. And I too wasn’t without the occasional scare. A rather aggressive and persistent young man decided to grab me when I wouldn’t buy a pair of his shoes from the market, and despite telling him with a rather stern voice to leave me alone, accompanied by a decent push, he continued topursue me for about 500 metres along the road. The sad reality was that I couldn’t trust anybody to come to my aid so was left to resolve the situation as best as I knew how. But hey, you haven’t travelled through Africa as a young white female by yourself if you don’t get hassled at least once.

Earlier in the day I went to Kunduchi Beach, about 20km north of the city, where located within the Kunduchi Beach Hotel was the Wet n’Wild water park. I arrived at 11am and for the first 2 hours was the only person in the park, other than the odd staff member walking around attempting to look busy. The park had about a dozen pools and the same number of water slides, which for anyone who knows me is my idea of heaven. I just wish there was actually somebody else with me to enjoy it. Eventually a Muslim family arrived. Talk about feeling underdressed. I was in my togs, and they were in more clothes than I think I’ve ever worn since stepping off the plane in Arusha 3 weeks ago. It’s no wonder none of the children could swim. The weight of their clothes alone would be enough to sink a battle ship. They also made use of the prayer room, situated at the back of the park. Not something I’ve ever seen at a swimming pool before, but great that the family could still enjoy the water without it interrupting their daily religious commitments.

The ferry terminal to Zanzibar was about 3km from my hotel, and with the ferry leaving at 9:30am and boarding commencing at 8:30am, it meant I had an early start the next day. I still had to purchase my ticket, which much like everything involving a credit card in Africa is a bit hit and miss, so I had to prepare myself for a difficult battle with the ticketing people. First they said the machine was broken, then they led me to about 4 different counters before I actually spoke to someone who understood English, but somehow I miraculously managed to buy a return ticket, wasn’t ripped off and made the ferry with about a minute to spare before boarding. I think I’ll call that my first of many successes of the weekend. While the locals sit (or stand) outside, tourists enjoy an air-conditioned, serviced cabin equipped with TV’s and complimentary food and drink. Not bad at all. It only took 2 hours to make the crossing, and before long I was lapping up the island life on Zanzibar. And I definitely wasn’t disappointed – it really is as stunning as the pictures you see in tourist brochures. But only if you don’t step more than 100 metres inland from the beach resorts. I very much doubt many tourists would even venture that far. Not when there are miles of white sand beaches, the aqua blue waters of the Indian Ocean and as many cocktails as you could possibly imagine to keep you entertained. I though, decided to take local transport while on the island, rather than fall for the tourist trap that exists. Hotels will charge exorbitant prices for tours to different parts of the island, but having spent all of 30 minutes on the internet discovered that I could also reach these places using the local daladala. Consequently I managed to travel from one end of the island to the other (a distance of about 100km) for the grand total of $3, instead of the $150 the hotel wanted to charge. Success number two – not getting ripped off and travelling with the locals! There are of course more advantages than just saving money when one travels with the locals. I got chatting (as I so often do) with the chef of a restaurant at Nungwi beach – who organised a boat trip to one of the adjacent beaches for a nominal fee. I also got to witness the true Zanzibar, which is a far cry from the tourist resorts scattered along the coastline. Small villages almost identical to those I have seen in Arusha were hidden away amongst banana plantations, filled with people struggling to make ends meet. That didn’t stop me of course getting sucked in to the tourist way of life, and most of my time was filled topping up my tan, swimming and snorkelling in the pristine blue ocean, enjoying a massage, and rehydrating at one of the many beachside bars.

I stayed in Stonetown while on the island, a town comprising predominantly Muslim people. There are over 50 mosques but only two cathedrals, one Catholic, the other Anglican. So not to embarrass myself, unlike many of the completely ignorant tourists who got off the ferry wearing nothing more than their short shorts and skimpy singlets so to reveal every conceivable inch of pasty white flesh, I ensured I was appropriately covered up while taking on a walking tour of Stonetown. In 32 degrees and 90% humidity (felt like 40 degrees) it was a struggle to say the least but I wasn’t going to be one of “those tourists”, and as a result was very warmly received by the locals. Success number three – not making a fool of myself. While I could write paragraphs on the history of Stonetown, I won’t. But I would highly recommend reading a bit on it as the town enjoys a colourful history, which includes none other than Freddy Mercury himself. I even managed to find the house he lived in as a child, mind you it was decorated in a lot of Queen memorabilia so wasn’t too hard to spot amongst the many palaces, mosques and other buildings of interest scattered throughout the town.

On my final day I took a boat trip to Changuu Island, more commonly known as Prison Island. The island is most famous for its Aldabra Giant Tortoises, a gift from the Seychelles. Through my uncanny ability to get things for the local price, the entire trip set me back less than $10, compared to the $90 the hotel wanted. I also quickly became a favourite with the tortoises as I had learned the night before to buy a bunch of bananas to take over and feed to them. On arrival most of them were in a deep slumber but before long the scent of bananas had them all chasing me around the sanctuary. One so eager in fact that all 150kg of him managed to stand on my foot – something I’d rather not have repeated in a hurry. The oldest was a guy aged 192 years, weighing over 200kg. The youngest, only a few days old who could easily fit into the palm of my hand. Wonderful creatures with a pretty sweet life I imagine.

And sadly, after 5 wonderful days away my little retreat to the ocean was over. A 45 minute flight back to Arusha was all it took, but in that short time I managed to befriend an English chap who had lived in Tanzania in 18 years. We exchanged stories of our experiences in Africa, mine far tamer than his – he’s had malaria 3 times and dengue fever once. He’s invited me to the golf course on the outskirts of Arusha this weekend, from where you can see Mt Kilimanjaro and Mt Meru in a single frame. I hope you enjoy the many photos from my time in Dar and Zanzibar and if you ever get the chance I would highly recommend a visit!

Lost in Translation

drfrenchie — Thu, 3 Sep 2015 18:08:00 GMT

One of the biggest challenges I have found since being in Tanzania is being understood. I don’t know whether it’s my kiwi accent, or just the fact that what I am asking is so foreign that any question I ask is assumed and the answer I receive may be something entirely different to what I am expecting. Either way, it usually takes about five attempts of going back and forth before I get a reply that is only slightly on par with what I want. When at all possible I will speak what very little Swahili I know – thanks to my iPhone app and help from my host family my vocabulary is now approximately 30 words! But even then, that can create more hassle than it is worth, as it will be assumed you are fluent and from then on in the conversation is almost exclusively Swahili. At this point I nod, smile and pretend to follow what’s going on. It seems the only place I am remotely understood is the hospital, where the language spoken is medical jargon, a truly universal language. That being said, I’m still completely out of my depth when it comes to tropical medicine. It is an area of medicine that is not taught to any great extent in NZ medical schools, mostly due to the extremely low incidence of tropical diseases that we would ever come across. So, my introduction to adult general medicine was somewhat like being thrown into a deep ocean and not being able to swim. My ward round on Day 1 went something like this:

Patient 1 – A middle-aged Maasai man with tuberculosis. The most fascinating part of his history was the fact he had 3 wives and 30 children (yes, 30 children!)

Patient 2 – A young man who upon being questioned by the doctor as to why he was in hospital, responded with “Doctor, it is because I have no blood”. We never did get to the bottom of his true complaint, let alone make a diagnosis.

Patient 3 – a 29yo male with alcohol-induced liver disease and renal failure. He thought that abstinence from alcohol was making him worse, thus resulting in his admission to hospital. In part he was entirely correct, as he was suffering with alcohol withdrawal. However, in terms of his liver damage, that was irreversible.

Patient 4 – A young HIV positive woman whose disease was at the stage where the virus had essentially diminished most of her CD4+ immune cells. She had recently started anti-retro viral medication, meaning her immune cells were beginning to recover, however this caused a massive widespread auto-immune attack of her body. She was semi-conscious and it was unknown whether she would survive the onslaught.

Patient 5 – A young 8yo boy with appendicitis, who had been symptomatic for 10 days but did not have easy access to the hospital so consequently suffered in an outlying village for many days. I’m not sure why the child was in the adult’s ward, and despite a request for urgent surgery it was 3 days before anything happened. Luckily the appendix didn’t rupture.

Patient 6 – A middle-aged woman with a blood sugar level of 30mmol/L (normal is 7-11mmol/L). Clearly they don’t have diabetic monitoring at home!

Patient 7 – An HIV positive woman with pulmonary tuberculosis who was non-compliant with her medication. This was of particular concern as she requested to be discharged, yet at home there were a couple of young children, to whom she posed a huge risk of transmitting Tb.

Patient 8 – A woman with typhoid fever – that is all I can report on as it was one of those ‘lost in translation’ moments on the ward round. I think I’ll do a google search.

Patient 9 – A known hypertensive woman in her 60s who was also non-compliant with her medication. She presented that morning with chest tightness and within 1 hour of reviewing her on the ward round, prior to her even making it for blood tests and a chest x-ray, she passed away.

And this was only the first of four rooms!

One thing that has struck me most since beginning my placement at St Elizabeth’s hospital is the reliance on a thorough history and physical examination of the patient. Consultants in NZ have often reinforced the importance of taking a good history and not forgetting to carefully examine the patient physically. Much of this lands on deaf ears to many of us, as we are all too familiar with the plethora of investigations available at our finger tips which will often provide the answers to allow us to formulate our diagnosis. But even the most basic investigations, which we take for granted, are not readily available in Tanzania. Liver function tests measure only 2 enzymes in Tanzania, yet in NZ we are provided with the results of 6 or more enzymes (which still confuse me!). Something as simple as a blood film can take over a day to return a result, meaning doctors must treat based on an assumed diagnosis, from what they have deduced from the history and examination. Not an easy task, especially when patients aren’t always specific with their details, nor are they willing to disclose certain information for fear of being judged by the doctor. And forget about getting a radiology report – interpretation of x-rays and ultrasounds is left the doctor in charge of that patient. If you’re the on call doctor you are left in charge of looking after the entire hospital afterhours – a thought that terrifies me!

I have spent a couple of hours this week teaching four visiting Tanzanian medical students who are doing a 1 month placement at St Elizabeth hospital. They are in their second and third years of study. Gaps in their knowledge are pointed out by the daily occurrence of quizzes by the general physician, much to the entertainment of many of the patients who listen so astutely to EVERYTHING the doctor says, regardless of whether it is relevant to them or not. As previously alluded to, privacy in this hospital is a luxury that could only be dreamed of so everybody knows everything about each other’s problems, medical history, last bowel motion and every other bodily function.

On Wednesday following the ward round I assisted a doctor with an antenatal and postnatal clinic. The clinic typically starts with a 1 hour education session – providing information to parents about appropriate care for their child. This is the first example of any health education imparted by doctors or nurses to patients that I have witnessed, which really surprised me. Even a small degree of health literacy amongst the Tanzanian population would go so far in preventing so many of the problems that are encountered and which cost so much in terms of human and financial resources. The number of people that lack knowledge in basic hand and food hygiene is incomprehensible. The clinic was attended by over 50 women, mostly without their husbands, and every single one of them was HIV positive! Worst still was the fact that many of the babies had been exposed to HIV during delivery meaning they too were infected. A sad reality of the state of antenatal care in Tanzania. As the entire clinic was in Swahili, the extent to which I could assist was limited to taking blood pressures and weighing the patients. A small but hopefully helpful contribution.

Tomorrow (Friday) I head to Dar es Salaam on a coach bus, a trip that is meant to take 10 hours. Only time will tell how long it will actually take. I am spending Saturday in Dar, before taking a 2 hour fast ferry to Zanzibar on Sunday morning. I fly back to Arusha on Tuesday evening, ready for 3 days of surgery. I plan to do nothing other than lie on the beach, soak up some Vitamin D and drink cocktails – a much needed respite from the craziness of St Elizabeth Hospital.

Photos: Fruitful Orphanage

drfrenchie — Mon, 31 Aug 2015 22:55:00 GMT

More Tanzanian Tales

drfrenchie — Mon, 31 Aug 2015 22:54:00 GMT

As I sit here scoffing back an ice cream, recently bought from the local supermarket that I have only just discovered, thanks to Nobete, the 8yo boy that also lives in the house, I find it hard to believe that I am already into my second week in Arusha. And much like the first week, it has filled with a heap of new experiences, some more pleasant than others. And with a greater sense of familiarity for their way of life, I am beginning to truly appreciate the simplicity people in this stunning country enjoy. Opportunities are created by the most miniscule of material possession, and despite such hardship in my eyes, there is nothing but happiness and love. But the one thing I will NEVER get used to, despite how hard I try, is the concept of Tanzanian time. Everything is done so polepole (slowly), I find it near impossible to comprehend how people actually ever achieve anything in their day. From walking slower than a snail, to it taking at least 5 times longer than it really should to do anything, it’s no wonder nobody suffers from stress! Just walking down the street I am constantly finding myself stuck behind women, children and men going about their daily business, many pushing wheelbarrows far too large for the footpath to cope, oh and as well as the odd goat or cow. But of course attempting to pass them would require stepping onto the road, and that would be like taking your life into your own hands. With pikipiki and daladala speeding down the road and no sense of road rules whatsoever, I decide it’s better to just slow my pace and join them in their daily stroll no matter how slow.

So back to the ice cream. The best thing of course about the fact I am eating an ice cream, apart from the obvious, is that I have recovered from my Tanzanian tummy. The result nonetheless of my fragile stomach mixing with a lunchtime stop off at a street stall in Moshi (a neighbouring city). The street stall looked reputable, the smell was delicious and the food even better and having survived two weeks already I really thought my stomach would be up to the challenge. Clearly I was wrong. My trip to Moshi was somewhat last minute, but I’d heard it was worth visiting so decided I’d head there for a day out. First problem was not knowing how I even get myself to Moshi. With a bit of confusion about where exactly I was meant to get the bus, I set off at 8am on what became a mighty adventure, involving 3 daladala, two buses and a taxi. Getting the dadadala to the Moshi bus stop can’t be that hard, right? Haha. Try doing it when you’re amsungu (foreigner) and have no real idea of where exactly this bus stop is located. In an attempt to pronounce the right destination, the dadadala assistant nodded so I jumped on board. Assuming I was heading in the right direction, I sat there working out what I should do once I make it to Moshi. I’d heard the markets were great so that was to first on my itinerary. The rest of the day I’d work out once I actually got there and found my bearings. And that is about as far as my itinerary actually got, because I didn’t actually arrive in Moshi until 1:30pm, by which time I needed lunch, hence the quick stop off at the street stall. As I should have predicted, the dadadala I was currently sitting on wasn’t heading anywhere near the Moshi bus stop, but instead to some residential area on the other side of town. I’d never been to that part of town, and before long the dadadala stopped, kicked me off, the assistant promptly informing me that I needed to head in the other direction if I wanted to get back to Kilombero market (a place I did actually know). So, by this time it’s already gone 9am and I’ve not yet even found the bus stop. But I have been on a dadadala to the other side of town. I guess that’s a bonus as I doubt I would have seen that side of Arusha otherwise. At 10:45am, after yet another major detour on the daladala I make it somehow to the Moshi bus stop and find myself sitting on an extremely crowded bus. The smell was overly familiar. Much like the smell of the hospital, minus some of the bodily fluids. And this bus had windows, thank goodness. I really don’t think I would have survived otherwise. I was told it would take about an hour to get to Moshi, so that wasn’t too bad. I forgot to add on the Tanzanian time tax, meaning the trip actually took over 2 hours, but I arrived, albeit exhausted, hungry and completely over the day before it had even barely begun!

I did find the market and managed to barter my way to a pair of traditional African trousers, a necklace and a bracelet for the grand total of about NZD $15. I felt very proud of myself, especially when upon returning I showed mama my purchases and she was very impressed with the price I paid. The trip home was even more adventurous, and somewhat worse than my morning’s dramas on the dadadala and bus. I jumped on a bus back to Arusha at 4pm precisely. The bus didn’t actually leave Moshi until 4:50pm and it was 8pm when I finally got home. Don’t ask me what took so long because I couldn’t tell you. I’ll just put it down to Tanzanian time.

The rest of my weekend was spent laid up in bed resting and recovering from my dodgy stomach.

On Monday I returned to St Elizabeth hospital for more eye opening experiences and I most certainly wasn’t disappointed. I attached myself to Dr Quaker, the Romanian paediatrician, for her ward round. Many of the children were different to those I had seen the week before, with just a few familiar faces, including the dear wee 2 year old with extra pulmonary tuberculosis and AIDS. Her mother sat vigilant by her side, barely able to vocalise more than a few words, but her facial expressions spoke a thousand words. There were two children on the ward with tuberculosis. Fortunately for at least the second child, whose condition was far better, there is a fantastic anti-Tb programme in Tanzania that has been set up by the WHO. The programme has meant much earlier diagnosis, and therefore far more effective treatment of children with Tb. Treatment is intensive, and compliance is a big challenge, but with regular follow-ups in a Tb clinic, the prevalence of Tb will hopefully begin to decline. Much of the Tb is contracted from drinking unpasteurised cow’s milk. Mothers, in their endeavour to provide more adequate nutrition to their young children, supplement breast milk with porridge made with cow’s milk. Unfortunately, bovine tuberculosis is rife, and these children are innocently infected.

Most of the ward round comprised the usual diarrhoea, vomiting and pneumonia. Pneumonia, malaria and dehydration remain the biggest killers of children in Tanzania, yet can be so easily prevented and treated with some basic health education and accessible medication. Any child who presents to the hospital with a fever is automatically screened for malaria, because a missed diagnosis could kill a child in as little as 24 hours. Nearly every child is treated with a cocktail of antibiotics for a minimum of 5 days even if the clinical picture points to nothing more than a viral infection. I expect this is because of the extremely high incidence of secondary bacterial infections, but I dread the day that Tanzanian bacteria become multi-resistant to antibiotic treatment.

On Tuesday I had the opportunity to visit a small orphanage in the suburb of Usa, on the outskirts of Arusha. Just getting there took over an hour, involving a 40 minute daladala ride and a short hike into the wilderness through banana plantations, but at the top of a very long hill the Fruitful Orphanage awaited me. Children of all ages came flooding in my direction, with grins wider than their faces, each and every one of their little bodies wanting a hug. As if a day on the paediatric ward wasn’t hard enough, this experience was on a whole other level. Attempting to keep my emotions in check, I entered the orphanage with 2 or 3 children hanging from each arm and leg. For two hours each morning the children attend class, where they receive lessons in maths, English and geography. Lessons are given in Swahili to the younger children, and English to the older children. For the lucky ones, overseas sponsors eventually gift money allowing them to attend a proper school in the city. For the remainder, this is the only formal education they will ever likely receive. I was allocated the older children for morning class, of which there were only 4. I taught them maths and English and was overwhelmed by their politeness and willingness to learn. There were no complaints, only an eagerness for more. Had lunch time not been fast approaching I could have continued for many more hours. Lunch was porridge, served in either a large or small cup depending on the age of the child. I had already been made aware of the infamous porridge so commonly served to young children in Tanzania from Dr Quaker, who detests the stuff. She blames it for the increasing incidence of malnutrition and I can see why. The porridge was nothing more than water mixed with two other ingredients, neither of which offered any nutritional value to speak of. I can’t imagine it tasted of anything either. But, like a scene from Oliver Twist, each child lined up for more, politely waiting their turn for a refill of their cup. It was at this point I didn’t know whether to cry or scream. I found myself questioning why these children were not being fed a more varied diet. The orphanage was set in the middle of a banana plantation but I can almost guarantee you none of these children have ever tasted one. The name of the orphanage was even a misnomer! There was certainly nothing fruitful about the food they received. I spoke to the other volunteers about my concerns and made the suggestion that once a week a volunteer attend a local market and buy some fruit and vegetables. It would cost nothing more than $10 and provide these children with the much needed nutrition they were so desperately deprived of. And with that, Operation Fruit and Vegetables at Fruitful Orphanage had its induction. A small air tight and lockable container was obtained, and each week a different volunteer would provide the supplies. Here’s hoping it continues. After lunch, I helped build a small shed, to house a cow that will be bought with donated money in the coming weeks. The orphanage already owned about 20 chickens, although I’m really not too sure what the intention of the cow or the chickens was. The chickens didn’t lay eggs (that I could see) and the cow had better not have bovine tuberculosis. I intend to go back to the orphanage next week to see how my little operation is going and offer suggestions for further nutritional interventions, including the possibility of a vegetable garden. I will keep you updated!

So apart from my usual hospital days, the remainder of my week was taken up with a couple of walks around the city, one of which I stumbled across the High Court and Mt Meru hotel. It was a hot day, my walking buddy, Amelia (another volunteer from the UK) and I were feeling thirsty and tired so we decided to stop off for a drink in the hotel bar. It was there I discovered the swimming pool I will now be visiting at least once a week. The cider went down a treat too.

This coming week I’ll be doing general medicine and infectious diseases. I intend to spend this evening reading up on Malaria as I haven’t got much of a clue about it other than it’s a parasite transmitted by mosquitoes and the second biggest killer of children in Africa. I don’t think that knowledge will help me much somehow.

On Friday I’m heading to Dar es Salaam and Zanzibar for 5 days. I can’t wait to go swimming in the ocean again. In fact just seeing the ocean will be nice!

Photos: St Elizabeth Hospital

drfrenchie — Sat, 22 Aug 2015 18:09:00 GMT

Photos: Arusha

drfrenchie — Sat, 22 Aug 2015 17:51:00 GMT

St Elizabeth Hospital

drfrenchie — Sat, 22 Aug 2015 17:49:00 GMT

My placement while in Tanzania is at St Elizabeth Hospital, a short 15 minute walk from my homestay in Sakina. The walk to work each morning attracts the occasional unwanted stare, many “hello my friend” comments by locals and a large dose of dust for good measure. I have decided that washing in the morning is futile as by the time I get to the hospital I am coated in my own layer of brown powder anyway. At least I have my scrubs to change in to so I can at least try and resemble a semi-respectable human being. Unfortunately the same cannot be said of my gym shoes or my socks.

St Elizabeth hospital is a 100 inpatient bed hospital, and one of two public hospitals in Arusha. The other is Mt Meru hospital on the other side of town. St Elizabeth hospital makes Wellington Regional Hospital look like a palace. It is primitive to say the least and appears very run down, both on the outside and the inside. There is a maternity department (with delivery suite, antenatal and postnatal wards), paediatric ward, medical ward, a single theatre and two surgical wards (one for males, the other for women and children), an isolated diseases ward (for HIV/tuberculosis/malaria/cancer patients),an eye and dental clinic, an outpatients clinic which caters for orthopaedic and medical patients as well as the usual immunisations and wound dressing changes, radiology (xray only), a medical laboratory, and a pharmacy. There are about 5 doctors working at any one time and the fact that there are only 100 beds certainly does not limit the number of patients being treated. Patients are squeezed into every conceivable space, with two, three or even five or more patients to one bed with many more lining corridors and the hospital grounds.

Each morning I walk in through the guarded entrance, much like entering a prison. The entire hospital grounds are surrounded in high fences, inside of which are a number of buildings painted in a mixture of white, pale blue and grey. The entire place needs a decent paint job, but given that they barely have enough money to buy essential medication, I imagine paint is the last thing on their mind. Cleaners can be found in every corner of the complex, hosing down and scrubbing floors at all times of the night and day. Despite this, the smell of the hospital is something else. As I approach the general medical ward, located upstairs above maternity and theatre I brace myself for what is a mammoth punch to the sensory cortex. An odour so pungent it takes your breath away and so powerful you don’t need a strong African coffee to wake you up in the morning. A visit to the medical ward is enough to curdle milk. It is of course the smell of unwashed humanity confined to a space too small for it to handle. Windows are kept constantly open in an attempt to create a breeze and I have learned very quickly to stand upwind of any patients if I can.

Day 1 was mainly an orientation and introduction to the many staff (doctors, nurses and administrators) that run the hospital, as well as a tour of the different departments. I have decided to spend a week each doing obstetrics, paediatrics, surgery, and infectious diseases, with another week in xray, the laboratory, pharmacy and outreach medical placements in Maasai villages. My sixth week will be on a safari, as well as a trip to Zanzibar. I expect my weekends will mostly be spent visiting local attractions in and around Arusha. I can work whatever hours I like, so I aim to arrive at the hospital between 8:30 and 9am and I leave between 2 and 4pm depending on what is happening.

My second day in the hospital began in the delivery suite and before long I was up to my arm pits in blood. I delivered two babies and sutured episiotomy tears, something I could only observe during my training in NZ. While it was probably the most terrifying experience of my medical training so far, there isn’t much you can do other than roll up your sleeves, and get on with it. Oh and pray that it all goes as expected, which of course it never does! The first lady had a massive post partumhaemorrhage that took 2 hours to control, but of course a blood transfusion was never an option. The second patient was a young Maasai lady who became so exhausted delivering her first child that when push came to shove she forgot to push. Needless to say, the labour was obstructed, the baby got stuck and came out breathless and limp. The obstetrician then became the paediatrician, doing everything in her means to bring life back into this wee soul. Her determination paid off and the wee girl started crying after about 30 minutes. While all of this was going on, I helped the nurses clean both beds as there were many more expectant mothers in the adjacent room waiting their turn to deliver. The delivery suite is a small poorly ventilated room with three beds each separated by a thin white blood-stained drape that offers absolutely no privacy. Women are required to provide their own sterile gloves and cotton wool as the hospital is not equipped to supply this. The beds, like all the beds in the hospital were rusty, dirty and in need of some serious maintenance. The foam mattresses were wrapped in a plastic cover to allow for quick cleaning and turnaround before the next patient arrives. There was however, a state of the art incubator for the babies so they could be kept warmpost deliverywhile the mother was sutured and nursed back to a state where she could walk to the adjacent post natal room.

Women’s and children health is paid for by the government, making up the majority of patients in the hospital. All other services must be paid for by the patient. Day 3 began with a caesarean section delivery of twins. It was to be my first of many theatre experiences and I really don’t think I was prepared for what I was about to see. The first challenge was finding a set of theatre scrubs that fitted. Being the perfectionist that I am I insisted on finding a matching top and trousers. That was the first mistake! The cupboard was filled with an array of mismatching items, none of which looked like they were even clean. I found a light green top. Mission impossible then began. Finding a matching pair of green trousers that actually fit me was a pursuit more difficult than a week of night shifts. The first pair I retrieved from the cupboard were so short they might as well have been shorts. The second pair, so large and without a draw string I risked exposing my underpants. The third pair, which I decided to put on were about 5 inches too short, and I looked completely ridiculous. But time was of the essence. The anaesthetist had already done the epidural and the obstetrician and her scrub nurse were armed and ready. Here I was, fumbling around the theatre looking for a hat and face mask. Twin one was delivered before I was even dressed, with twin two arriving just as I entered the theatre. It didn’t matter though, as I could see what was going on from where I was changing. There were doors but they were never closed.

The concept of sterility is an interesting one for an African hospital. The patient lay naked on the operating table, the surgeon and nurse in gowns that were most probably washed recently. The same couldn’t be said of my scrubs I don’t think. After the surgery, the patient’s abdominal scar was dressed in gauze stuck down with duck tape. The surgeon de-robed and her gown became a cover for the patient so they at least had some dignity while being transported from the theatre to the post natal ward. To transport the patient, the anaesthetist and I erected a makeshift stretcher, made from a thick plastic sheet and two wooden poles. This was then placed, with patient, on top of a trolley lacking any form of an adequate frame. But, like most things in this hospital, it was functional and the patient was delivered safely to her hospital bed, although it too was of questionable stability.

Following the caeserian section, I joined the paediatrician for her ward round. There is only one specific paediatrician at St Elizabeth hospital, a Romanian doctor who has lived in Tanzania since 1989. Her late husband, a Tanzanian man was a gynaecologist at Mt Meru hospital. She is a fantastic teacher, although at times I think her Swahili is better than her English so we don’t always understand each other. Fortunately there is a young Tanzanian medical student, Lucy, whose grasp of the English language is impeccable. We will get along perfectly!

Paediatrics in Tanzanian is far more complex than what I have experienced in NZ. There are many cases of neglect and malnutrition, superimposed on an already high number of comorbidities, many of which are serious. Poor health literacy is and will continue to be a big problem, especially amongst the Maasai tribe. Traditional medical practises continue to be the mainstay of treatment for these people. I witnessed two examples of “witch medicine”on the ward round. The first was a small child no older than 1 year, who had two deep incisions in his gums, right down to the bone. Apparently this is for administration of a herbal remedy, but from where I stood it was nothing more than an excellent access point for infection. This child was at significant risk of a cerebral abscess and death so it was unsurprising that he was into his sixth day of continuous fevers. The second child was slightly older, how old exactly I couldn’t tell you, but he had about 20 or more small vertical scars across his lower abdomen. On questioning the paediatrician about this, her response was simply “this child victim of traditional medicine”. That was enough of an understanding for me. But the most tragic case I saw all morning was that of a 2 year old girl, who lay listlessly in the hospital bed with her mother by her side. Her mother appeared exhausted and desperate. The father was dead, presumably from AIDS. I say this because the poor wee girl had extra pulmonary tuberculosis and AIDS. She weighed 7kg and was nothing more than skin and bones. I really wish there was something I could have done but I was completely helpless. Sadly, the paediatrician was in the same position.

And that concludes my first week at St Elizabeth hospital. Who knows what awaits me next week J

Arusha

drfrenchie — Sat, 22 Aug 2015 17:48:00 GMT

For the next 6 weeks I am based in the city of Arusha, located in the north eastern part of Tanzania, approx. 170 miles south of Nairobi, Kenya by road.

To say it hasn’t been a complete culture shock would be lying. Since disembarking my plane at Kilimajaro International Airport (picture a single building plonked in the middle of baron land at the base of two beautiful mountains, Mt Meru and Mt Kilimanjaro), I haven’t stopped being overwhelmed by one eye opening experience after another. The drive from the airport took about an hour, along a sealed road lined with everything ranging from corn fields, open paddocks, goats, cows, rabid stray dogs, Maasai and Meru tribal people,Msugu (white people), and intermittently dispersed small villages comprising shops tattooed in pepsi cola signage and houses that resemble something between a mud hut and a concrete building with a tin roof. I was collected by a lovely gentleman named Paulo, and his driver, Jason. Paulo waited for me outside the terminal with a handwritten sign, which put a lovely smile on my face after what had been two very long days of travelling to get here.

Before long we arrived at the homestay house in the suburb of Sakina. I was greeted with a warm hug from my host mama, Merylin, her husband, Talent, a daughter, Novian and two grandchildren, Nobete (8 years) and Jericho (2 years). Mama had prepared lunch for me, which I kindly obliged despite wanting nothing more than a long hot shower and a sleep.

My host family are simply stunning. Their hospitality and kindness is indescribable. It is hard to say exactly how many family members live in the house as there appears to be so many comings and goings I struggle to keep up. I can say though that Mama has an open door policy and welcomes everyone that wants to stay. She and her husband have seven children, Joanne (usually lives in South Africa), Catherine (usually lives in Dar es Salaam with Nobete who is orphaned), Thomas (Dar es Salaam), Noela, Novian(mother of Jericho) and Norman (all in Arusha) and Nora (deceased mother of Nobete). I have met all of them except Thomas.

Mama spends most of her days cooking and cleaning. The food she prepares is simple but most certainly sufficient, both in terms of its nutrition and quantity. Breakfast typically comprises “white bread” with peanut butter or jam, black tea (as milk is both expensive and impossible to keep fresh), and fruit. My allergy to bananas has never been so problematic as the staple fruit in Tanzania is the humble banana, but mama has kindly substituted this for oranges or papaya. I provide my own lunch when working in the hospital, and we eat dinner at around 8pm in the evening. Dinner always consists of rice and/or chapatti, meat and vegetables (sweet potato, peas, carrots, cabbage, kale and avocado). For good measure, the others throw a banana in the mix!

The biggest challenge in Arusha seems to be a reliable electricity connection. Power is typically cut for up to 20 hours of the day and my host family cannot afford a generator or solar power. A hot water cylinder hangs precariously from the toilet ceiling, but is simply a vessel for holding cold water. With no power the water never heats. Showers are cold and from a bucket and the flush toilet has no seat. I currently have a bedroom to myself, although should another volunteer arrive I will share with them. The house is situated within a large compound that is locked at night (for my own protection more than anything). I discovered last night there is a bar situated right next door that has generators, wide screen TVs that play football and delicious beer. Mama and Catherine both needed to charge their phones so we decided to head over there before dinner, and 5 beers later (kindly donated by other patrons as I was somewhat a celebrity) we stumbled back to the house at 10pm. At least I now know where I can charge my laptop, camera and phone should I need to.

The city of Arusha has a population of 400,000. It is elevated so enjoys a much cooler climate than coastal Dar es Salaam. That is if you can call 30 degrees cool?! It is currently the dry season, so dust is a big problem. While the main streets are tar sealed, the footpaths and side roads are not, so dust gets everywhere. It is completely impossible to avoid and you are resigned to the fact that after every venture out on to the street you will return completely coated in a layer of dust in places you never thought possible. Street vendors line every metre of available space, each and every one of them relying on the custom of others to survive. I really don’t see how many of them make any money as I am yet to see people stop and buy things. There are two or three large markets within the city, where most people buy their produce as they can barter for their goods. A large supermarket (Nukumat) is located in the Msugu area, which caters for the travellers and rich Tanzanian locals.

Public transport is an experience not to be missed. There are three options, all of which would scare even the most seasoned traveller. Pikipikiare motorcycles which you double on the back of but the driver is the only one that wears a helmet and the speeds at which many of them drive has visions of near death experience written all over it. That, and the fact that so many patients at St Elizabeth Hospital come in with Pikipiki related trauma. Oh, and there is apparently no road code so it’s a free for all. Honking the horn and weaving in and out of cars going in all directions is the only way to get to your destination. The second option is the Daladala. This is a minivan, with 10 or so seats, and anywhere in the region of 25-35 passengers. The driver and his assistant will not leave the side of the street until there are sufficient numbers of paying passengers. The assistant hangs from the window, yelling at potential passengers as the daladala screams along the over crowed streets, dodging pikipiki, people, street vendors and anything else that might get in its way. A single fare (unlimited distance) costs 400 Tanzanian Shillings (approx. 40c NZ) so is a suitable option for locals and budget travellers looking for a bit more excitement in their day. The third, and most reliable and safe option is a taxi. I’m yet to experience a taxi so can’t comment but I’m pleased to say I have survived both the pikipiki and daladala, although I don’t think I will be using the pikipiki again during my stay in Tanzania. Once is certainly enough for me!

Photos: profile pic

drfrenchie — Thu, 13 Aug 2015 19:19:00 GMT