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:

I've Got 98 Problems...

And problem number two is Kiswahili.

It's easy enough to learn the basic greetings.

"Hujambo."

"Sijambo."

"Habari gani?"

"Nzuri sana, na wewe?"

"Salama."

Or, informally:

"Mambo!"

"Poa."

After that, it quickly turns into an uphill climb. I had not expected to move to Tanzania before I landed the job at FAME, and I've never studied any Swahili before. When I lived in Chile, it took a while to get up to speed, but I could communicate with anyone who took the time to slow down and work with me. Not so in Tanzania. No English? Back to pointing and grunting. I'm pretty much starting from zero.

I've picked up a new textbook, and I'm studying flashcards for vocabulary, but progress is painfully slow. It feels like I'm right in that liminal zone where I need to be exposed to Kiswahili more, but I still don't have very much to say.

I'm thinking about going to the orphanage down the road to hang out with the kids, since they probably won't mind if I sound like a blithering idiot.

I've also started running with one of the Tanzanian doctors here, Dr. Gabriel, and he's been helping me work on my Swahili then. Dr. Gabriel is still trying to get back up to full speed in the running department, so my side of the bargain is to encourage him to run just a little farther while he drills me on vocabulary.

One of the hazards on our running trails is elephant dung. They come down from the forest at night in search of corn and bananas. We never see them though because they always head back into the hills before dawn. Here's a picture of Dr. Frank trying to keep Molly from rolling in this fresh pile.

My latest scheme for learning Kiswahili was to download Anki, a piece of flashcard software that will let me make audio flashcards. Now I just have to rope a native speaker into helping me with the Swahili side. I'm a little concerned that I'm spending too much time tinkering with study aids as opposed to actually studying. It might be best to simply hire a teacher for regular lessons. That would provide some structure plus a strong commitment for a certain amount of time per week.

 I'm very open to suggestions on good ways to proceed in this language learning venture. If anyone has any good ideas, please let me know.

In other news, the bungalow where I'm living is very nice. I'm going to be sharing it with a Canadian nurse, but she's out of the country, so I have it to myself for the moment. The view from the wraparound porch is quite good at sundown, and it has perfectly spaced pillars for my hammock.
Here are pictures of the porch and the view:

The house also comes with three rather unfriendly cats, who are constantly fighting, hissing and yowling at hours hours of the night.

Here's a picture of one of them trying to look innocent and not fooling anyone.

In defense of the cats, one of them caught a flying bat last night out of midair by performing a five-foot vertical pounce. That may well be the coolest thing I'll ever see.

Speaking of bats, next time, I'll share something you probably never knew about fruit bats.

A Late Night, an Early Morning and Traffic

Last night we had a farewell party for Dr. Reed and Dr. Rich, two visiting doctors from DC. Most of the (off-duty) clinicians were there, and we drank the last of the beer that Reed and Rich had bought for their stay. Sometime during the shindig, someone received a call saying that a couple of critical patients were one their way. This is rare at FAME because usually critical patients simply arrive unannounced. (Yesterday we had a dead patient brought into the outpatient clinic for treatment; I don’t know how they got the body into the doctor’s office without the clinic staff noticing he was deceased.) Anyway, nobody gave it much thought because often, “critical patients” decide they might not come right after they call but instead wait for morning. 

After the official party, we headed into town to find a bar and send the doctors off in proper fashion, but on the road to Karatu a white Land Rover flew by in the opposite direction with flashing lights. Ambulances are very rare in Northern Tanzania and typically mean something serious, so we turned around and brought the doctors back to work.

It turned out that two American tourists on safari had been in a car crash in transit from the Serengeti to Ngorongoro Crater. Dr. Reed pronounced one in the ambulance and the other will need to be evacuated by air this morning. Luckily the driver (who was wearing his seat belt) was unhurt. We can’t afford to evacuate Tanzanians, not even to Dar Es Salaam. There are lots of phone calls to be made when an American needs to be flown out (and when one dies in Tanzania too) so it’s been a busy morning for everyone. I’ll go with the patient to the airport, so that I can learn about the handoff procedure in case I ever need to organize a medevac.

The lab at dawn:

Last night at the party, I told one of the local doctors that the big thing I was afraid of in Tanzania was riding in a car. Karatu, a town of 20,000 has only one paved road. All the other roads in the area are dirt tracks, steep, frequently lopsided, washed out, filled with cattle, and impassible in the rainy season. Tanzanians don’t really go in for speed limits (difficult to enforce when most of the traffic police lack weapons or vehicles), so instead they use speed bumps… everywhere. If you have kids, you build speed bumps in front of your house and their school because otherwise people will drive as fast as they can. The government also builds them. Most of the speed bumps are made out of the same red dirt as the road, so you can’t see them until you are almost on top of them.

There are also lots of pedestrians crossing the road, some of them very young, some inebriated, some herding cattle, some all of the above. The highway is full of heavy trucks moving at slow speeds and Land Rovers swerving around them at high speed. In short, not a safe place.

To cap it all, people get around on motorcycle taxis (called piki pikis) where you cling precariously to the driver’s back as you bounce over the speed bumps. He has a helmet; you don’t. A friend of mine was very distraught because she saw a man killed in front of her after he bounced off a piki piki on the highway. Later in the week, one of our volunteer doctors found the “dead” man very much alive in the government hospital. He shook not-so-deceased’s hand and they took a picture together to show the friend who saw the accident.

UPDATE: In my previous post, I asked for help with our EKG machine, and I’ve gotten a lot of great advice and connections, including someone who knew someone who knew someone who knew someone who works at GE Healthcare. I’ve submitted a full report on the issue directly to that person, so hopefully we will see some progress there soon. It couldn’t come at a better time because Dr. Reed left this morning, and we will now have to rely on long-distance cardiology consults. Many thanks to everyone who helped out.

Bonus picture: Popi, the hospital's mascot. She's a Standard Tanzanian Dog. All dogs look about the same here, I suppose because there aren't any fences.

I've Got 99 Problems...

And the first is an EKG. A month ago, the software for the EKG gave up the ghost. You can see the rhythm on the laptop screen, but when you press print, it conjures a mysterious error message. As the only person experienced with PCs, they tapped me to fix it on my first day at work in Africa.

Fortunately, the manual lists common problems with step-by-step solutions. Even better, the list includes our mystery error. Unfortunately, the fix doesn’t work. Of course, we’ve lost the disks, so reinstalling is a no-go. Everything else I’ve tried just sent me around in circles. I’d hand it over to an IT specialist, except it seems there aren’t any in this part of Tanzania.

As a stopgap, I taught the nurse how to take screenshots so we can at least have some record of the 12 lead EKGs. If anyone knows anyone who knows anything about Cardiosoft (by GE Healthcare), I could sure use a consult. My resources to fix this problem are as follows:

1. Me

2. A finicky Internet connection

3. The Cardiosoft setup on a Dell Inspiron 1505

4. $25

Dr. Frank, The Boss, rated this problem as a 5/7 in terms of importance. If we can’t print EKG’s, we can’t do telemedicine with cardiologists in the US. This is problematic because Dr. Reed, our volunteer cardiologist, leaves on Saturday. As I said, if you know anyone who can help troubleshoot, send him or her the link to this post or my contact info.

In the meantime… GIRAFFE!

Chapter Next

"I learn by going where I have to go."

I'm just wrapping up my first week at the FAME Africa clinic in Karatu, Tanzania.

I thought I would keep a detailed account here, vividly describing my experiences in Tanzania, but there's too much. From the moment the plane descended: the mud huts, the dust devils, the people everywhere, giraffes in the road, Dr. Frank's booming voice at the clinic, the Maasai in traditional dress getting an echocardiogram... it's too much to wrap my head around in one go.

So instead we'll take things one day at a time. I'll try to post regularly, although life has been very busy here for the past week. In keeping with my last few moves, this part of my life seems like it will have very little to do with what came before it.

I'll try to put pictures up too, even though I never remember to take my camera out.

Until next time... birdhouses.

Inhabited by some colorful and very chattery weavers just out the window of my office.