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.