High Tech

Just because Tanzania is a developing country doesn't mean we can't use technology. It's just harder.

No piece of technology more advanced than an inclined plane works as billed in this environment. You have to fight for every functional moment. Examples:

Dr. Joyce brought a conductivity meter to test distilled water. The machine came from a reputable firm, was factory calibrated, and arrived new in the box. Doesn't work.

We set up Dr. Frank's simple and reliable battery charger to do some electrolysis rust removal. Very basic setup: water, washing soda iron cathode, iron anode, solid electrical connections. Doesn't work.

I bought a brand new, light-up watch in the market. Doesn't work.

Backup Internet modem... doesn't work.

Lamination machine... doesn't work.

Microscope camera...doesn't work.

To cap it all, we have a long succession of failed hard drives.

One of the major problems is dust. Karatu is dusty all year except for the rainy seasons, when it's muddy. A big chunk of our most delicate, and expensive, equipment is located in a special room in the laboratory. This room is one of three on campus equipped with an air conditioner (the other two being the operating rooms). Last time we had a massive dust storm blast through, the windows were left wide open. Why? The lab techs said the air from the air conditioner was too dry, and it gave them a headache. Dr. Joyce (one of our lab volunteers) was ready to pull her hair out.

The most recent problem is ants. They live in the rafters and come trooping down every day to eat the serum that gets tested in the diagnostic equipment. Dr. Joyce has one of the techs clean the wall twice a day with bleach to disrupt their navigation, but still they come.

Every day the techs go forth to combat an unrelenting onslaught of swirling dust and swarming ants. Except for today, since it's pretty nice out. But usually...

In some ways, though, Tanzania is far more advanced. Even in largely developed countries, like the US, we don't have anything nearly as high tech as laser ketchup.

PS I have started shucking and roasting the coffee I brought back from Kessy's house at Kilimanjaro. Early attempts have yielded mixed results, but I continue forward, undaunted.

Problem #7

When it rains, it pours.

The new surgical wing means that soon we will be able to do emergency C-sections, and that means we are on our way to providing labor and delivery services.

This means that we need a room to do it in. We have a room picked out, and a special bed on order, but the problem is that the room is right next to all the other patient rooms in the ward. This may lead to some unfortunate noise issues.

So my new challenge is to find a way to soundproof the delivery room using locally sourced materials and little to no money. The other issue is that my boss, Mama Susan, wants it to be an aesthetically pleasing space inside and out. It's a fairly large room, with two exterior walls, two windows, an inclosed bathroom, and a double door to the ward.

My resources are:
1. Me
2. probably up to $100 or so
3. a crew of groundsmen with extensive carpentry skills
4. a car (for fetching supplies)

I'm open to suggestions.

UPDATE microscope problem
It turns out that there is a problem with the camera itself, which I cannot fix. So I am trying to get the manufacturer, Olympus, to take it back for repairs. They aren't returning my emails or answering their phones so far though.

In the meantime, we are pursuing the stopgap measure of adapting a different camera. I already wrote about trying the point and shoot option. This has not produced very satisfactory results.

Thanks to Vickie suggesting phone cameras. As outlandish as it might sound, this may be a viable option. Thanks to Nathan for telling me about Skylight, a product that lets you take pictures with recent model iPhones through the microscope eyepiece. I've been in touch with them, and they agreed to donate a skylight for FAME. I hope we can work it out to arrive before the end of December. That just leaves the problem of finding a an appropriate iPhone. Mine is first generation, and it has very limited photographic capabilities. We really want a 4S or later model, and I thought that Dr. Frank had a stockpile of them somewhere, but it turns out that all of his are older models too.

UPDATE gym equipment problem
I finally got around to pouring my concrete weights. Below is a picture of one of them in the frame:

I borrowed some leftover bricks from the new volunteer bungalow, and built a fairly creditable bench as well. As soon as my shoulder gets better (I'm having some rotator cuff tendonitis issues), it will be ready to go.

Coffee, surgery and banana beer

Things remain interesting.

Our surgical ward is soon to be opened! Soon we will be able to do life-saving procedures here instead of referring them to Arusha-- some three hours' drive away.

The only downside is that the offices had to be reshuffled to clear out the surgical ward, and consequently I got booted from my nice big office to my new closet. This was not unexpected. When the most junior, least important staff member has the nicest office on campus, it's not a stable situation.

Old Office

New Office

 In other news, I just got back from a trip to Kongo, a little village on the slopes of Mt. Kilimanjaro. A friend of mine (who stays in the same house in town), has four weeks off work (he's a teacher), and he invited me to come meet his family. One five-hour bus ride, one one-hour dala dala ride (mini-bus), one boda boda (motorcycle taxi) ride, and one half hour walk later, we arrived.

Kongo and its environs are everything that I expected of equitorial Africa-- small villages clumped on steep tropical slopes, banana and coffee cultivation, everything green except the red soil.

I had a great time, and actually managed to take a few pictures too.

Here is a view of the landscape around Kongo.

Here is one of myself, my friend Kessy and his faithful steed-- the piki piki (motorcycle).

I also got a chance to learn about making coffee. It's one of the main cash crops in the area. I got some practical experience with every step of the process from planting to drinking. I knew surprisingly little about where coffee came from before. It turns out that the fruit is pretty tasty all by itself.

Here are some coffee beans in different stages of the coffee making process. From left to right, unripe fruit, ripe fruit, extracted beans, dried beans. The ones on the far right are ready for roasting.

I also learned about banana beer, the local home-made alcohol of choice. I had tried Karatu's local brew--millet beer-- on market days. That stuff tastes like someone ate a bowl of gruel, chugged a bottle of vodka and then vomited it back into your cup. Proper etiquette for drinking millet beer involves blowing the mold on the surface away from the edge of the cup before you drink. They serve it in giant plastic mugs that probably haven't been washed since they left the factory, and the men imbibe gallons of the stuff.

The banana beer on the other hand isn't so bad. It has a sweet flavor and not nearly so much mold.

Here is Kessy with a generous ration.

The hospitality I found at Kessy's house was very nice. The whole family was extremely welcoming, interested in teaching me about Tanzania, and interested in learning about America as well.

Here is the whole household together.

They sent me off with a kilo of coffee and an invitation to return. Then Kessy saw me to the bus station in Moshi, where we encountered a terrible choice.

I had brought a really excellent novel for the trip: The White Tiger by Aravind Adiga. It was so good, I finished it on the trip there and had nothing to read on the way back. Fortunately there was a book store close to the bus stop. Unfortunately, the only English offerings were this...

  or this...

I'm sorry to say I made a horrible mistake. Next time I'll learn about juicing.

Quick thoughts

I don't have much time to write, so here are some quick notes.

1. People here wave with both hands, but they don't actually wave their hands. They wave at you by putting both arms in the air like freeze-frame jazz hands.

2. Squat toilet pro tip-- take your phone out of your pocket first.

3. There is always a rainbow and always a giraffe. If you don't see them, you just aren't looking hard enough.

4. I have a new project: trying to soundproof the future labor and delivery room. Women should be able to scream if they want to, but we don't want the other patients getting the wrong idea.

5. For some reason, a lot of people (mostly tourists on vacation) bring toothbrushes to donate to us. You can buy toothbrushes everywhere in Tanzania, and they only cost 500/- (about thirty cents). Why don't people bring things we actually need, like ant traps?

6. Our laboratory is under attack. The ants like the serum that gets tested in the lab equipment, and it's a constant struggle to keep our most delicate (and expensive) equipment protected.

Hope to have more time to write and post pictures tomorrow.

Short Rains

The short rainy season has officially begun.

It started with a blast of rain and a plague of frogs. The rain lasted 15 minutes, the frogs for two days. I don't know where the frogs all came from. Hundreds of thousands of them appeared seemingly from nowhere. The kids chased them across the backyard. They hopped over everything, onto the porch, into the hall, across the road. Thousands upon thousands tried to cross the paved highway in a terrible, mass act of amphibian suicide.

In two days, they had all gone, disappeared back to wherever they came from.

A week later we got a second storm. It was raining barrels. I woke up at 5:00am to the strangest sound. At first I thought someone was running a big engine, but then I realized it was rain. Buckets and buckets of it. Mama roused out all the girls (at 5:00am mind you) to clean off the concrete patio while the water lasted. This was followed by a plague of termites.

In a rush. Will post pictures tomorrow.

Problem #6 and Thanksgiving

One of my projects for the past several weeks has been trying to get our microscope camera to work. For seven months now the camera has idled while patients have gone undiagnosed. I spent two weeks working with Olympus tech support, reinstalling and updating everything we could think of, swapping out any component I could to try to get a differential diagnosis. Finally, I've reached the conclusion that the problem is in the camera itself, and I don't have the tools or the expertise to resolve a hardware problem like that. So now I'm trying to arrange a way to return the camera to Olympus for repair, but they've stopped answering my emails, and telephones are a bit tricky across so many timezones. Persistence is key.

In the meanwhile, I've been working with Dr. Joyce, our lab guru, on a temporary replacement. We had an old 3 megapixel microscope camera in a drawer somewhere that had also been shelved with a software problem. That turned out to be fairly easy to fix, so now we have very limited imaging capabilities. Unfortunately, the webcam built into most phones provides better images than this piece of junk. That got me to thinking about using a regular digital camera instead, since a run-of-the-mill point and shoot today has just as good resolution as the $50,000 camera we are trying to fix.

It turns out that some hobbyists do use point and shoot cameras for microscope photography, but they typically employ expensive adapters. I tried using a toilet paper roll to make an adapter for my point and shoot, but the image is way too small. I think the problem is that the camera has a built in lens designed to provide a wider field of view than just what is directly in front of the sensor.

Another option is to try a DSLR with no lens. We have an old full frame DSLR that was donated, but I haven't the foggiest idea how to go about building an adapter for it. I would also have to deal with the problem of camera shake from the mirror flipping up and down. We will see how it goes.

In other news, here's a cool bird I saw at Lake Manyara.

It turns out that it's reasonably affordable to visit the national parks if you have a residency permit (half off at the gate) and if you have a friend with a safari vehicle that you can use instead of hiring a guide. I went to Lake Manyara National Park (about thirty minutes down the road) with some friends last week, and had a great time. It's not far from Karatu, but the landscape is completely different because of lower altitude and more water. It's like a rainforest in some places but also has wide plains, and also it's full of elephants. Proof:

It was a fun time with a very interesting group. We had an octogenarian surgeon, a former NSA mathematician, a Maasai warrior, a cardiologist, me, and two kids. The latter two intrepid explorers were a lot of fun because they got very excited about every animal we saw. Later in the day, they didn't find the elephants nearly as exciting however.

It had been a long day of exploring...

And we had already met plenty of elephants anyway.
















We also spied an antelope with his antlers screwed on the wrong way around.

You can see what they're supposed to look like on his buddy in the background.





















Finally, it turns out that part of my job is to organize a Thanksgiving celebration for the medical volunteers. At great expense, I acquired a turkey, and then I sent off to Grandma for help on how to cook the thing. It turned out reasonably well, and I think that a good time was had by all.

River of Mosquitos

Another mystery solved.

I went down to Mto wa Mbu (river of mosquitos) for my first day off (after working for over a month now). It's a slightly smaller town about half an hour down the paved road. (We only have one paved road in our district.) Right at the bottom of the escarpment, it sits in a lush spot where water runs down from the highlands and into Lake Manyara. It looks completely different from dusty Karatu. There are banana trees and rice paddies everywhere, and everything is green green.

First I visited a school that a friend of mine works at. It's about four miles outside the town, and as soon as you get past the edge of town, the water dries up and you are in a desert of termite mounds and Maasai bomas. For the uninitiated, a boma is a set of dwellings-- usually mud huts-- with an enclosure for cattle made out of brambles.

I got to help teach a couple of English lessons, visit with the kids, and check out the awesome scenery.

It turned out that the only way to get back to town was to ride a boda boda, or motorcycle taxi. I had avoided these so far because they are, frankly, very dangerous. To my surprise, it turned out to be a lot of fun. We went back via the raised paths in between rice paddies, puttering along over bridges made out of half a log stuck between berms, slapping hi fives with little Maasai kids along the side of the path. 

My second objective for the trip was to find the second young heart patient to try to take a picture to raise money to send her to Israel for surgery. I got directions to the children's center that was her last known whereabouts and took off in Blackie, the faithful 4x4 Toyota I have on loan from FAME. About three miles down a dirt road, I came to an impassible section covered in downed trees and turned left. I soon figured that was a wrong turn because it dumped me into a plain that during the rainy season is underwater in Lake Manyara. So I stopped to ask some Maasai herders for directions, and they pointed me back to the obstructed road.

I had to leave Blackie behind and continue on foot. Eventually I found the compound. At the gate, there were guards with spears who were very friendly but very insistent that I was not going to go inside unless invited. So I chatted for a while in my broken Kiswahili, and eventually a Dutch woman came out to talk to me.

Apparently the little girl had already had heart surgery in Germany, paid for out of pocket by one of the volunteers at this children's center. She was doing just fine now. This was very good news and resolved my quest. I exchanged phone numbers, got a quick tour, and headed back to Karatu.

On the way back, I saw my first wild monkeys, and took some very nice pictures which I later deleted by accident. The only one that was saved, I won't post because this is a family-rated blog. Sorry.

One little thing

This is a bit of a sad story.


About a month ago, I was in Dr. Frank's office looking for some cable or another when he beckoned for me to come behind his desk and look at his computer screen. At first I couldn't tell what I was looking at. Then I realized it was a picture of a little girl curled up on a procedure table. Her skin looked like it was made out of dogwood bark. She hardly looked like a human being at all. Dr. Frank said this was a patient who had just come in. He had no idea what was wrong with her, and he was putting together a report to send off to his dermatology contacts for a consult. Dr. Frank was a cardiac anesthesiologist by training, and he readily admits that a lot of the things he sees in Tanzania, he doesn’t know much about. So he has cultivated an extensive network of clinicians around the globe who have agreed to provide pro bono consultations within their specialties. Anyway, I was a little shaken by the photograph, but it was my first week in Africa, and it was soon pushed from my mind by a torrent of other goings on.

After a few weeks, though, I started to notice a tiny figure being pushed around the clinic in a wheelchair. She was wrapped up in cloth so that you could hardly see the person inside.

Then one day, Nancy, one of our long-term volunteer nurses, told me the story of the little girl in the wheelchair. She had come to the clinic some years before with the same skin condition. Her skin just died and built up into a thick layer like a lizard continuously shedding its skin but never scratching it off. The first time she came she was, aside from her skin and some minor infections, a perfectly healthy little girl. Then she disappeared for two years, and we hadn’t heard of her until she came back last month. The details are vague, but as best I can tell, when she was five, her mother had another baby and she took the little girl with the skin disease and put her in a bed in the back room. She stayed in that bed for two years, curled in the fetal position, wasting away from a healthy girl with flaky skin to the skeletal figure I had seen in the photograph on Dr. Frank’s computer.

Eventually some of her aunts grew concerned, perhaps because of the smell, and convinced the mother to let them bring her to the clinic. When they brought her here, she could hardly speak, couldn’t control her bowels, couldn’t stand… She had been curled up for so long that her muscles had atrophied and her tendons had shrunk so that she couldn’t straighten her legs. Nancy said the biggest problem would be the psychological damage from being alone in that bed for so long. She needed as much stimulation as possible to help her come back from that.

It just so happened that earlier that day I had been cleaning and organizing the office when I found a giant, 64-color box of crayons tucked away in a corner. So I pulled out the best ones, stole a coloring book from the volunteer supplies and headed down to the ward.

The head ward nurse, Mama Mshana, was on duty, and she said I could go in an see the little girl. (She approved of the coloring book I guess.) When I went into her room, at first it looked like someone had just forgotten to make the bed. She was so small that her body hardly made a lump in the wrinkled sheets. Her skin looked better than before but still covered in a thick layer of dead, flaking tissue. Her hair had started growing back in in patches. Her eyes were closed, and she didn’t move at all when I came in.

“Is she asleep?” I asked.
“No. She just ate,” Mama Mshana told me.
“Can I touch her?” I said. Mama Mshana nodded. So I reached down and shook her little foot. At first no reaction. Then, without opening her eyes, she smiled.
“I knew she was faking,” Mama Mshana laughed. She helped the little girl sit up (she was so small) and showed her the crayons and coloring book I had brought. I was worried she wouldn’t know how to hold the crayon because she had never been to school. (My mother tells me this is an issue for some kids.) But she had no problem at all and immediately grabbed a crayon and started to carefully fill in, all inside the lines, a beautiful, blue cow.

It was a touching moment for me. If I had ever doubted that I was in the right place, doing the right thing, this was the sort of moment to put those doubts to rest.

I try to visit her every day if I can. I usually bring my guitar to play some songs (she says she likes the music) or a pad of stickers or some more colors of crayons. I talk to her in what little Kiswahili I have. I get Mary, the receptionist, to help me translate picture books so I can read to her. Some days she won’t give me the time of day. On a good day she’ll say a word or two. On a really good day she smiles.

The doctors are working on special leg braces to keep her legs straight at night. The nurses have a strict exercise schedule to help her relearn how to stand and, eventually, walk. It hurts a lot; you can hear her crying when they help her onto her special walker, but you’ve got to do what you’ve got to do.

I’m not sure what will happen to her or where she will go next. We finally got a diagnosis from a doctor in Germany. It's a genetic disorder that causes her to be unable to produce a certain enzyme. Her condition can't be cured, but it can be managed. I shudder to think of what would have happened if she hadn’t had this place to come to. For now its best to focus on helping her learn how to be a kid again: to walk, to smile, to draw, to laugh. The rest is just the rest, and happens after.

Problem #5

Between the laboratory and the vehicle batteries, FAME uses a lot of distilled water. Of course, "a lot" is a relative term. We need about 1-3 gallons per day, which doesn't seem like very much until you consider that the nearest supplier of reliably sterile product is in Dar Es Salaam-- nearly 500 miles away over roads most Americans wouldn't subject their worst enemy's four-wheel-drive Jeep to.

We want a way to distill water ourselves to ensure a plentiful, reliable supply so that we can run laboratory tests so that we can provide good care to our patients. I know that we can buy an electric still here in Tanzania, but the problem is that it uses a lot of electricity. We get electricity from Tanesco (the state-owned power company), but it's expensive and often unavailable. We've had at least one outage per day for the past four days running. We can also use our nice, new generator, but that uses diesel fuel, which is expensive and often unavailable. (About half the time I try to buy gasoline, there isn't any.) We also have some solar panels, but they are overworked as it is (4 kW capacity for a clinic, an inpatient ward, a lab, and five houses).

My number one solution so far is solar distillation. Solar stills seem relatively simple, don't use any electricity, and could easily produce enough distilled water to meet our needs. The problem is that I don't know of anybody who makes them in Tanzania. You can buy them in the US, but then getting it here would expensive and difficult to do without breaking the glass.

I did some reading on the Internet, and I don't see why I can't just build one myself. After all, kids make them for seventh grade science projects. I reckon that puts it only slightly above my technical expertise (I'll ask a grown up to help me with the power tools). I found some simple designs, and also this cool-looking design by Gabrieli Diamante. I would love to try the latter, but I can't find the designs, despite the project supposedly being open-source. I also think I would need some outside help to make the Diamante design work.

The critical thing I don't know is if the solar distillers will make pure enough water for our batteries and lab equipment. I could use some help on this one. If anyone knows anyone who knows anything about solar distillation or laboratory distilled water standards, please send them the link to this post or my contact information.

My resources to work on this project are:
1. Me
2. Dr. Frank's very nice set of power tools
3. Access to basic construction materials.
4. Probably not very much money.
5. Sugru!

In other news, it turns out that my pretty princess palace (read mosquito net) is not scorpion-proof. I woke up last night with fairly severe, right-sided chest pain radiating to my neck, jaw, arm and wrist. I thought it might be a spider bite, but I couldn't find any marks or bumps or discoloration. I couldn't figure out what was going on, so I took some ibuprofen and went back to sleep. When I was making my bed this morning, I found this little guy:

It felt like I'd been stung by a wasp, except that wasp venom dissipates after a few minutes. The pain from the scorpion sting decided to hang around, talk about old times and maybe stay for dinner. It took about two hours before it dulled enough for me to fall asleep again.

In the morning I caught him with a Frisbee to show to the family. For those of you who have been wondering about this, I can definitively report that upside down Frisbees will not restrain an angry scorpion. He (or she) got out, and I had to apply lethal force with a Michael Ondaatje novel. If anyone's interested in scorpions and can identify it from this picture, I would love to know what type it is.

UPDATE: on the problem of medication ports and IV tubing. I'm trying to work out a deal with Medshare and generous reader in Atlanta so that we can get these supplies shipped to volunteers who are coming to FAME.

UPDATE: on the problem of disappearing keys. We've found some giant carabiners to attach to the most important ones.

BONUS PREVIEWS: I'm going to start in on that biopsy microscope I mentioned in a previous post, and tomorrow is the big market day in Karatu.

Sweet Nectar of Life

By special request, I'm writing a post about water and sanitation.

I recently had the following questions asked:

"What is sanitation like? Presumably there is running water in the clinic, but is it at all common anywhere else? Do you have to boil water? Indoor plumbing, or all outdoor? Laundry in washtubs? Are water- and insect-borne diseases a big problem (malaria, typhoid, yellow fever, for instance?) "

Sanitation is a bit of a mixed bag here. Some people live in houses that are fully plumbed, and some live in mud huts with no running water or sanitation to speak of. I'm not aware of any sewer systems, but many houses have septic tanks.
The clinic has its own borehole that goes down some 1,000 feet to the water table. It draws clean, fresh water that does not need to be treated or filtered to drink. We get it tested every year, and so far it's cleaner than most tap water you would get in the States. At the volunteer bungalows, we have a tanganyika boiler, which the askari fire up at about 5:00am, so we have hot, running water in the mornings.
It's a very nice setup really, but not common at all. Boreholes cost about $30,000 USD to drill, and there's no guarantee that you will actually hit water. FAME's first borehole dried up  after several years of use, and they had to drill another. Water shortages are a fact of life in Karatu, and during the dry season municipal water supplies can run out for weeks at a time.
In the house I'm staying at in town, the family has a 5,000 liter reserve tank that is filled from rainfall on the roof during the rainy season. Many households have some storage capacity, though 5,000 liters is relatively large.

Rain-filled storage at my house:

As for boiling water, I understand that most people do not. The water is NOT safe for someone like me to drink, but the Tanzanians' stomachs are equipped with different flora than mine. In my house, they boil all the water for drinking and washing dishes, but I think that's just because they know I'll get sick if they don't.

As for plumbing, we have indoor plumbing for the toilets, but many houses do not. There are faucets in the sinks, but they don't work. Instead we get water from the municipal pipes and from the reserve tank.

Our spigot for the municipal water source:

We have an indoor bathroom, with the squat style toilets are are universal here. In the picture below, I realize it looks pretty dirty, but in fact it's quite clean. The rather unfortunate brown and yellow marks are actually just caulk and paint spattered on the tiles. Tanzanians don't go in much for masking tape and drop cloths. (The carpenters and builders don't use measuring tapes, straight-edges or levels either.)

In the picture above you can see the yellow bucket with water for cleaning your left hand after you poop. (You only use your right hand for eating and greeting people.)

The shower is just a room with a drain in the floor. We have a shower head in ours, but I'm not sure if it works or not. For a hot shower, you heat the water in an electric kettle, and then add cold water until you get the right temperature. Here's the shower room:

The bath water is usually drawn from the rainwater tank, and it lives in a big metal barrel in the main part of the bathroom. Here you can see the bathwater barrel and the spear:

Laundry is done by hand in plastic wash tubs in the back yard. They get your whites very clean.

Water and insect-born diseases are a problem, but not as big a problem in Karatu as other parts of Tanzania, perhaps because the high altitude (5,000 feet) means fewer mosquitos. Typhoid is pretty rare, and so is Yellow Fever. We used to think malaria was rampant, then we got a better supply of testing kits, and it turned out that most people who thought they had malaria actually didn't. I still sleep in my pretty princess palace just in case. (It looks just like one that my sister had for her bed when she was twelve, only hers was purple.)

Pretty Princess Palace

I think that answers all the questions. If anyone else has questions, feel free to post a comment or shoot me an email.

Dust Storm

I experienced my first dust storm today.

This picture was taken in the middle of the afternoon, and the sun is shining even though you can see the wall of dust sweeping toward the clinic.

It was a slow day at the clinic, very few patients and little for me to do because I'm waiting to hear back on a number of emails. Suddenly the wind kicked up like a leafblower, and I looked outside to see a mass of dark grey covering the horizon to the East. The air smelled strongly of rain, but instead of rain we got a huge cloud of dust. For about fifteen minutes you could barely see the hill across the valley, and then we got a spattering of rain (which dried instantly), and then it cleared up.

When I sat down at my desk after, I noticed that everything was covered with a fine layer of dust. Luckily I thought to put my computer in a pillowcase when I saw the storm coming.

In other news, after I photographed the little heart patient, the powers that be decided that since I had some photography training, I should be detailed to all the photography projects. Assignment number one is to shoot our new operating room, which is nearing completion. After an unproductive session, I consulted with Erin Cook and tried again with better results.

Here's one we may end up using for the website:

And here's one that came out a little wonky:

Dr. Frank also set me up with a new camera that had been donated to FAME: an original Cannon EOS Rebel. It will go well with my original iPhone and original Kindle.

Here is the new machine:

In other news, last night was my first night staying in town with Baba Joseph and Mama Sauda. It's a very nice family, and I think I'll have a good time staying with them. They have another tenant who is the same age as me, a Tanzanian who teaches at at local primary school. It should be nice having someone my own age around.

I also got to experience my first bucket shower, which was surprisingly refreshing. Just make sure to keep your mouth closed. The water is not altogether clear. If you stick your hand in the bucket, you can see the end of your index finger on a good day.

Shida Nyingi

Shida Nyingi means "many problems".

I've had quite a few issues crop up in the past few days.

First after the EKG machine was fixed, Dr. Frank asked me to take a look at our remote controlled microscope camera (because no good deed ever goes unpunished). This fancy device was donated so that we could have specialists in the US conduct biopsies on samples in our lab here. The only problem is that once we got it here and set up, it turns out that it doesn't work, and nobody can figure out why. I'm going to start digging into it later today.

Second, I got an urgent email yesterday from Dr. Frank saying that we need pictures of two of our pediatric heart patients. A couple of weeks ago, Dr. Reed--a visiting cardiologist-- identified some cases that were good candidates for surgery, and he put us in touch with an organization called Save a Child's Heart. SACH is an Israeli NGO that does heart surgery for needy children, and they agreed to take some of our kids and raise the $10,000 needed for each child's operation. We just need to find the money to get the children to Israel for the surgery. Anyway, there's an organization in the US that is trying to raise the money, and they asked us for pictures of the kids to put in their publications. Of course Dr. Frank gets 10,000 emails per day, so this one sat for two weeks before he forwarded it to me. As a result, we need the pictures a week ago. One of the little girls lives in Karatu, and one of our staff knew her family so we drove to her house after work, and I snapped the shot.

Dr. Frank wanted me to drive out there on his four-wheeler ATV, but I declined.

For the other little girl, we've been having more difficulties. She was last seen at FAME a year ago. The telephone number we have on record is disconnected, and nobody can remember which orphanage she came from. Luckily a group came up from a school in her town today, and I met a girl from the States who said she would help track the little girl down and take the picture for me. Someone on our staff may also have more information on where to find her, but the clinic has been so busy today that I haven't been able to speak with him.

Third, we keep losing keys. The locks are all individually made, so every door in the hospital has its own key, and there are no masters. This can be a big problem if someone happens to walk off with the key to the central supply in his or her pocket. For the short term, we're looking at attaching the most important keys to a giant keychain, like the bathroom keys at gas stations. I'm working on designing an accountability system so that we can keep track of the keys, keep them organized and still get into rooms without a terrible hassle.

Fourth, we're running low on medication ports and IV tubing, which we typically get donated from the US. It turns out that most of our in-kind donation infrastructure (by which I mean contacts and relationships) was created by someone who has either left the country or died (I'm having difficulty determining which), and his network disappeared with him. So now I'm looking for contacts I can get to donate medical supplies and ship them to our volunteers to carry over in their extra luggage.

Tomorrow I'm planning on moving into Karatu to stay with a local family. That should be a good way to keep at learning Swahili since my spare time for studying has rapidly diminished.

I've Got 97 Problems...

The volunteer bungalow at dawn:

Fortunately I do not have the problem of getting shot between the eyes with a poison arrow. The same cannot be said for the patient who was helicoptered in recently.

After the initial shock of seeing a helicopter-- the first to ever come here-- details began to trickle out of the Emergency Room. The injured men (the other had his leg broken with a club) said they had been policing a game reserve and had gotten into a skirmish with a group of poachers. At first I thought they were government game wardens, but then it came out that they were privately employed and guarding a private reserve. They arrived in a helicopter after all, and they were accompanied by a white man who wore shorts so short he must have been a white African. Both these details suggest the invalids were not associated with the government.

Their story about poachers seemed flimsy. If they had actually been interdicting poachers, they probably would have been shot with a firearm rather than a bow and arrow. A more likely explanation is that they had tussled with some of the semi-nomadic Datoga cattle herders. I'm told that several wealthy foreigners have bought up large swathes of land for private hunting reserves, and often the Masai and Datoga don't even know that the land they are herding on is no longer public. I imagine the Datoga wouldn't take too kindly to being ordered to leave, especially if they were buzzed with a helicopter first.

Sorry for not taking many pictures. Here's another sunset:

Problem #3 is trying to find/or make a gym setup here. My shoulder is finally healed up, and I'm looking to start lifting again, but apparently weights can be hard to come by. I've been running most mornings with Dr. Gabrielle-- also an opportunity to practice my Kiswahili with him-- and I've found a conveniently sized tree branch for pull-ups, but aside from that I haven't been very active.

My current plan is to buy a steel bar and then make weights out of concrete that can fit on either end. There are several issues that need to be solved for this method though:
1. How can I mold the concrete so that each weight in a pair is the same size and weight?
2. How can I control how much each one will weigh?
3. How can I reinforce the concrete so that the weights do not crumble, crack or come apart?
4. What shape should I make the weights?
5. How can I make a stand that I can trust not to fail and drop the bar on me after benching?
6. How will the weights be attached to the bar?

In other news, I got to sit in on a class Dr. Duane gave on skin grafts. Dr. Duane is an 80 year old surgeon from Nebraska who is visiting for three months to set up our new operating room. He's quite a character, a down-to-earth, very hard-working former farmer. He just brought a new Dermatone machine for harvesting grafts and taught all of our doctors how to use it. It's basically a giant electric shaver that takes off the entire layer of skin rather than just hair. Very interesting stuff.

Dr. Duane (right) explaining the Dermatone to Dr. Mmile (left) and Dr. Gabrielle (center)

Kiddos

I spent the weekend at the Rift Valley Children’s Village, an orphanage 45 minutes East of Karatu. FAME sends a delegation of doctors and nurses every other week to care for their 70+ children as well as members of the surrounding communities.

I met the Rift Valley volunteer coordinator last week, and she invited me to stay the night and get to know their organization. They have a lovely campus, adjacent to a government school and sandwiched between coffee plantations. I got the full tour. The dormitories are extremely nice, and the children seem very well cared for. The kids all wanted to play with you and hug you and feel you and talk to you at the same time. I made the mistake of spinning one of them around in the air, which meant I had to do the same for everyone. I took a disk, which held some novelty value, but the kids immediately lost interest when the soccer ball came out.

Here's a picture one of the kids took of me and a friend. (She took a lot of pictures with my camera, but this is the only one where she managed to get our faces in the shot.)

Rift Valley also hosts a group of American volunteers, mostly in their twenties, who come to help take care of the children, teach English and help out around the facility. It was a little jarring to be dropped back into a group of normal Americans of my own age. We sat on the porch to watch the sunset after while the children were put to bed (promptly at 7:00pm), and then watched a Hollywood movie. In the morning, I hung out with the kitchen staff, learning more Swahili and teaching them how to make taco salad for lunch.

I’ll put up a few pictures of the trip, but I need to economize on Internet data because I’ve already blown through a month’s worth in the past week.

Here is one of the friendly RVCV dogs.

BONUS FRUIT BAT FACT: fruit bats sound exactly like cell phones beeping. When you are sitting around outside at night you occasionally have to wonder, "who is playing with a cell phone up in that tree?"

UPDATE: Problem #1

The EKG machine is finally fixed! After a very late night at in the clinic (the only way to exchange email in a timely fashion with the US is to stay up until it’s morning there), I was able to follow the instructions of someone who actually knew what she was doing. I followed her instructions very carefully, and everything looked good until I tried to plug in the electrodes and test the system. The old error had disappeared, but now the machine would not recognize that the electrodes were connected. This development, you can imagine, was very disappointing. However, when I mentioned the setback to Dr Frank, he said that the connection problem was a known quantity. All you have to do is kick the convertor box in a certain way, and eventually it will recognize the connection.

I still wasn’t’ sure if that was a satisfactory fix. Then, yesterday, Siana, the head nurse, came striding up to me with an expression that made me think, “Oh God, what have I done now?” Siana is only five feet tall, but she can project intimidation anyway. She walked right up, turned to Dr. Frank and said “Dr. Frankie, lift me up so I can kiss him.” Apparently she had just done a 12 lead on a heart patient, and it worked just fine for the first time in months. So I’m chalking this one up as a win.

Many thanks to Uncle David for putting me in touch with Carl Herde and Tom McGee at Baptist Hospital East. Thanks to Tom for putting me in touch with Clint Kaho also at BHE. Thanks to Clint for putting me in touch with Carl Meade and Shari Price at BHE. Thanks to Carl for putting me in touch with Robin LongenBach at GE Healthcare. Thanks to Robin for putting me in touch with Kim Moore at GE Healthcare. Finally thanks to Kim for patiently sifting through my troubleshooting report and showing me how to fix the problem.

UPDATE: Problem #2

Thanks to Tom Vernon for the suggestion of finding a local family to move in with. It’s going to be hard to leave the lovely house provided for me at FAME, as well as Eva, the cleaning lady who even washes my running shoes when I don’t hide them well enough. But I think it’s the right thing to do until I can get a better handle on the language. I’ve started the process of searching for a new place, somewhere close enough that I can ride the FAME bus that brings staff from town at shift changes and more importantly, somewhere that nobody speaks English.

Bonus bonus teaser: As I was writing this, we had a helicopter come in with two patients. More to follow: