Break Time

It's been an incredibly busy month at FAME: lots of patients, lots of volunteers, the first birth in the new labor ward, the first Caesarean section, many ambulance transports, and grant deadlines all piled on top of each other.


Then last weekend, I took my first days off in a month or so to do a one-last-trip with a friend who is leaving Tanzania to go back to England.

We decided to do a motorcycle trip to Lake Natron via Monduli.

The first challenge was getting the motorcycles in good shape. I recently traded my newish Toyo 150cc and a bundle of cash for a Honda XLR 250 that's long on character and mileage. It's the same model year as I am: 1990. I've spent the past month in and out of different motorcycle shops trying to get it ready for the trip. I had the carburetor cleaned and adjusted, the valves adjusted, the fork seals replaced, the turn signals and horn replaced and rewired, the choke and speedometer cables replaced, I adjusted and lubricated the clutch and throttle cables, replaced the clutch lever, replaced the oil seal on the shift lever, and had passenger footpegs and a skidplate custom made. Then she just needed a wash to look as good as she probably has in decades.

I used to feel like I needed a hunchback assistant and a bolt of lightning to start the thing in the morning, but now it fires up every morning on the first kick.

The night before our trip, we loaded everything up so that we would be completely ready to leave early in the morning. Here is everything loaded in the garage/living room.

At this point, the sharp-eyed reader may note that the front tire looks low on the XLR. This is because the tube had a puncture that we didn't notice until we got back at 10:00 that night. Fortunately I had purchased a spare tube the day before. Unfortunately neither of us had replaced a tube on a motorcycle before, and it took a long time to figure it out, and of course we put a hole in the new tube in the process. The second time took much less time, but still by the time we finished patching it was already 1:00 in the morning, which did not bode well for our crack of dawn start.

We finally got out the door at 8:00ish,  and stopped for a pre-trip portrait at the Lake Manyara overlook.

From there is was a two hour zip on pavement to Monduli. We had to stop and wait for the presidential motorcade. The presidents of Tanzania and the Congo were coincidentally also traveling to Monduli that day for the opening of a new military academy. We were first in line to go after the motorcade so we had the highway to ourselves going into Monduli. We had a brief stop there to fuel up and eat some chips mayai (a sort of potato omelet), then we were off the paved road for the rest of the trip.

We had a lovely winding journey through the mountains behind Monduli that dropped through a very steep, switch-back laden road down to the basin behind Mount Kitumbeine. I think we saw three cars (in one caravan) the whole way. Then we had a rocky, twisty road through mixed savanna and forest. Not many animals to be seen aside from innumerable antelope, just a few ostriches, giraffes and the occasional zebra.

We were chased for most of the day by a huge thunderstorm coming up from the Southeast and a dust storm from the Southwest. We finally sloughed into the dust storm right by a Maasai village where they were having some sort of gathering-- thousands of brightly dressed Maasai with their shukas being whipped by wind and dust in a strange half light. The temperature dropped by twenty degrees, and we started hitting mud pits in the road from recent rainfall. I drove through one, and the bottom dropped out. I was halfway submerged, but the bike kept running and motored out the other side.

We began to worry about running out of fuel about midday. We knew we had enough to get to Natron, but not back, and we hadn't seen anything like village where they might have gas. We had seen a village on the satellite imagery, but we weren't sure that the road we were on would take us through it.

We finally found the village about 3:30 in the afternoon and sure enough there was someone to sell us gas out of old water bottles. That was when the storm finally caught up to us. We pulled the bikes onto someone's covered porch and hunkered down with some Maasai kids to wait it out.

What a storm. You couldn't see five feet through the rain. It was like being under the ocean but louder. We worried a few times that the tin roof would blow off. But there was nothing to be done except share out some of our precious peanuts with the other people sharing the shelter.

After if finally blew itself out, we took a walking tour of the village of Kitumbeine. A stroll through the village quickly showed the damage: downed trees, mud slides, and roofs blown off houses. 

The road had turned into a raging torrent of water, so we decided to spend the night in Kitumbeine and press on the next morning. I'll try to get the rest of the trip posted soon, but here's a preview:

Telling Stories to Save Lives

My sister, Hannah, is raising money to make a new video for FAME. She has been working as a film maker in LA, and now she is planning to take a few months off to make the trip out to Karatu.

We have a lovely video about FAME, but it's sadly outdated. It was made before we had our laboratory, our hospital, our surgical center, or our maternity ward (which had it's first birth last week by the way), all of which we want people to know about.

If you want to learn more about the film she's planning or make a contribution to the crowdfunding push, check out her page on Indigogo (link below):

https://www.indiegogo.com/projects/sharing-stories-to-save-lives

Catching Up

Apologies for the delay between posting. It's been a bit busy around here.

In September I spent two weeks in Arusha attending a Swahili course, which was enormously helpful. The truth is, my language skills had plateaued for a period of about three months after I moved out of the place I was living with the Tanzanian family and finished the introductory textbook I was studying from. Still I felt inordinately proud of my ability to carry on a basic conversation, so long as the subject matter didn't deviate far from travel logistics, soccer, and motorcycles.

Ah, how little I knew about how little I knew. The first day in the classroom was a real eye-opener for how clueless I was when it came to advanced grammar. Someone once told me that Swahili was an easy language to learn because the grammar was so simple. I don't think I've ever been so thoroughly misinformed in my life. Perhaps people have that impression in the US because so few people from the US progress farther than learning the basic tenses, which are fairly straightforward. But underneath that superficial impression lies a complex set of verb-based structures that allow an extreme precision of meaning and subtlety of expression using a startlingly concise vocabulary. And all of it had gone straight over my head for the past year.

I enjoyed the course immensely and feel that I gained a much better foundation to move forward. The school, MS-TCDC, also had a lovely campus and a very talented teaching staff. The accommodations were very nice too, but the room and board fees were just shy of highway robbery, so I stayed with the parents of a friend of a friend in Arusha and commuted by Dala Dala every day. The last part of the commute was a nice walk with a view of the volcano, Mount Meru.

I also found another chameleon. I was surprised again by how terrified people are of the little critters. Still not entirely sure why.

Also, I saw something interesting while taking a walk around the perimeter of the school. Someone was growing some sort of edible greens on farms right in the middle of the river. They had built stone walkways all across the river to tend to the crop. I don't think I've ever seen that sort of riverine aquaculture before. It made for a nice place to take a stroll, so long as someone wasn't trying to go the opposite way on the same set of rocks.

A Social Activity

Right before I left the States, Grandma gave me a crash course in knitting. She keeps a few starter kits in her bag to ensnare the unsuspecting visitor at knitting group meetings.

I've started in on a scarf, which I have accidentally made twice as wide as intended. This has proven frustrating since it takes eons to finish a row. It may yet end it's life as a potholder.

Knitting, as a productive activity, runs somewhat counter to my normal mindset. When I'm working on the scarf by myself, I spend most of the time plotting ways to mechanize and automate the process. When I mentioned this to Dr. Joyce, one of our volunteers and herself a veteran knitter, she explained that, like quilting, it's supposed to be a primarily social activity rather than just manufacturing.

So I've started joining the Maasai ladies who do beadwork next door to my cottage. We all speak a little Swahili and shoot the breeze about what sort of livestock is kept in our respective homelands, and they never tire of asking what time of day it is in the USA right now.




Also, thanks to Heba for sharing some photos she took at our recent visit to Coleman's boma.

Here is a closer shot of the house:

 The decorations inside:

And our hostess with the corn-water gourd:

First Blood, First Boma, First Phonebook

Our blood refrigerator has it's first parcel. Sizya, a lab tech, got poked today so that we can be ready for a possible delivery. I'm next up on the donor list apparently.

Last week, Heba, a volunteer nurse practitioner, asked if it would be possible to visit a traditional Maasai village. She said she had seen a lot of interesting pathologies in our Maasai patients, and she was hoping a better idea of their home life would shed some light as to why.

The problem is that all of my Maasai friends live in Ngorongoro, which is a horrifically expensive place to visit if you aren't an East African citizen, which I'm not. It comes out to the tune of $300 per person per day. So I asked around a bit and in the end, Coleman, a member of the FAME staff invited us to visit his village close to Monduli, which is outside of Ngorongoro. The date was set for the next Tuesday.

We briefly considered delaying when I was hospitalized Sunday night for a suspected kidney stone, but I felt fine the next day, so we decided to go anyway.

Coleman's village was about an hour and a half drive from FAME. We started out on the paved highway, turned off onto a partially paved road, transitioned to a gravel road then a two track dirt road, then a one track dirt road, then no road at all, driving cross-country. Fortunately, our Toyota RAV4 is made of sterner stuff, and tackled the rocky terrain like a champ.

A Maasai village is generally called a boma, which refers to the thorny enclosure that surrounds it to keep the cattle in and the predators out. Coleman's boma had four houses, all made of mud and dung over woven sticks with thatched roofs. One house for his head wife her children, one for the second wife and her children, one for cooking, and one for storage. There were also two internal enclosures: one for cattle and one for goats. The RAV4 looked a little out of place, like a spaceship that had just landed there.

The houses were quite beautiful up close. The mud walls were smooth like driftwood. It was very dark inside because the only opening is the door, which serves as entrance, light source and chimney all at once. Coleman's first wife offered us tea. The Maasai idea of tea is fresh boiled milk with lots of sugar, waved in the general direction of a tea plantation and then drunk as is. Conversation stopped as everyone sat around slurping. Then Heba brought out one of the gifts she brought: two big jars of colorful gumballs. They turned out to tremendously popular. Coleman officiously took on the role of gumball distributer, and soon the sounds of slurping tea were replaced with smacking lips as the gum made the rounds.

Then we had a tour of the whole place. The second wife's house in particular was interesting because she had decorated it with all sorts of things, from medication packaging to Christmas tree tinsel. Anything bright, shiny or colorful had been saved and carefully tied to the rafters to liven up the decor.

We also walked around to visit some neighboring bomas, where they apologized for not having tea because there was no water.

Walking back to Coleman's house, we heard a rumbling sound, and it became apparent why he had wanted to come on Tuesday. It was the one day of the month that the four-wheel-drive lorry came around to sell corn, and he wanted to be there to personally oversee the negotiations, which took about half an hour.

Then we had a sumptuous meal of roast goat. I think the Maasai recipe is the best. There are only two ingredients: meat and fire. I also tried a kind of mashed corn floating in water that you drink out of a gourd. I may regret that particular decision in a few days, since I doubt the water was boiled beforehand.

We exchanged more gifts. We had brought shukas (a sort of plaid blanket) for the elders, and we received jewelry for Heba and a decorated club for me. Finally, we took some pictures together and then said goodbye. It seemed like everyone from a four mile radius came to see us off. It turned out we were the first foreign visitors to that particular community, or at least the first that anyone could remember.

Hopefully I will be able to steal some pictures from Heba's phone, since I didn't take very many.

BONUS FUN FIND

I was at a school office today, and I saw a phonebook, the first I'd seen in Tanzania. It turns out it wasn't a Karatu phonebook, but rather the directory for the entire country of Tanzania. Not a whole lot of landlines here. It was less than two inches thick.

South to Haydom!

Last week a couple of Norwegians (a pediatrician and a community health expert) came by FAME, and I showed them around. It turned out they were visiting from Haydom Lutheran Hospital, which is about 100 miles to our Southwest. After the tour, they invited me to come visit Haydom. I always enjoy learning more about healthcare in the area, so I said I would love to.

On my next day off, I saddled up the piki piki, and headed out before dawn toward Haydom. The road is all dirt and rock, winding through the hill country around Mbulu. It would have been a miserable drive in the car, but the dirt bike is built for that sort of thing.

Six hours later, I pulled into the gate of a major referral hospital in the middle of the wilderness. Haydom was opened in the 1960s on a previously uninhabited hilltop to serve an extremely rural population, mostly Iraqw and Datoga, spread out to the South of Lake Eyasi.

Now it serves as the primary hospital for 400,000 people and as a referral hospital for more than 2,000,000. With 450 beds (and I'm told up to 600 admitted patients at a time), it's a bit busier than our little clinic in Karatu. Each year, they perform 2,000  major surgeries and deliver 6,000 babies.

At first glance it doesn't look much different from other hospitals in Tanzania-- stuffy, poorly-lit hallways with beds packed into the wards and patients overflowing into the hallways. But going through department after department, you quickly realize just how many capabilities this facility has in comparison to other institutions in the area. Surgery, optometry, dentistry, inpatient, outpatient, HIV clinic, radiology, pediatrics, maternal and child health, labor and delivery, ICU, neonatal ICU, CT scanner... even a detox center.

Here's a view of their outpatient clinic, named for Ole Olsen, the Norwegian doctor who was the driving force behind the hospital until his death in 2005.

They also host a small contingent of international volunteers, and I had a very illuminating chat with their volunteer coordinator, who faces a lot of the same challenges we have at FAME.

The biggest issue for Haydom, not unlike many hospitals, is funding. Only Haydom's situation is especially acute since right now the Norwegian government is underwriting 66% of their budget, to the tune of three million dollars per year, and they are pulling the plug in 2015. It seems like nobody is quite sure how the hospital is going to deal with two thirds of their budget disappearing next year. They've known about the Norwegian government's plan to end funding for the past five years, but it's as if nobody thought they would actually go through with it.

It will be interesting to see how this situation plays out. The hospital is so important for so many people, and if they raise fees and cut services to cover the shortfall, the vast majority of their patient base will no longer be able to afford care there.

Back to work

I got back to Karatu after a month in the US.

It took me a week to catch up on sleep and email, but now we're back in business.

In the clinic, we have three new volunteers: a husband and wife team of globe-trotting nurses and a thoracic surgery nurse practitioner from California. I think they are all past the wide-eyed, slack-jawed stage of taking in how things work around here, and now they are getting into the swing of things too.

Ryaan, an ER nurse, has been digging around in our store rooms and is putting some useful stuff back in order. Here's a picture of Ryaan (left) working with Anthony, our lab director, to get some optometry equipment up and running.

We are also working on getting ready to start our Reproductive/Child Health (RCH) program. I saw some of the crew working on putting the new RCH office together today. If you were wondering how many men it takes to put together an IKEA style cabinet, the answer apparently is four: our physical plant director to supervise, a groundsman for consultation, the laboratory manager for quality assurance, and one carpenter to actually put in the screws.

We hope to have the RCH office, maternity ward, and prenatal health program in service and ready to go by the end of this year.

In other news, old habits can prove useful. Ever since living in New Mexico, I've always shaken out my shoes each morning to dislodge any scorpions that may have taken up residence during the night. I do this even when I'm staying in places with no scorpions. Yesterday when I was shaking them out before walking to work, I evicted this guy:

I think of shoe shaking like knocking before opening the door of a portable toilet. I'd rather do it all my life and never need to, than not do it once when I need to.

I also went on a trip this week to a big referral hospital to the south. It was quite an experience. I'll try to do another post when I get a chance to look through the pictures I took. Apologies for the photo quality. My camera did not survive my trip to the US, so everything is taken on my museum-piece original iPhone.

New Place

Today we had the first sunny morning in a long time. Maybe the long rains are finally ending.

I've been asked to post pictures of my new house, so here you go:

It's about a fifteen minute walk to the clinic along a lovely path. It has electricity (usually) and hot water when I can be bothered to fire up the wood burning boiler. I have the kitchen all to myself, so I can cook whenever I want.

It's also out in the country instead of in the middle of town like my last place. That means no call to prayer being blasted out at 5:30 in the morning. Instead just more roosters, but they don't usually cut in until 6:30am.

Since it's a bit of a walk to town, sometimes it can be harder to get to the store to pick up this or that. Necessity is the mother of invention, and hunger is the mother of strange dishes. The grocery situation has led to some kitchen experimentation. One product is the Egg-Guac sandwich: fried eggs, guacamole and melted cheddar on toast.

Next time, I'll try adding some lettuce or sliced cucumbers for more crunchiness.













Here's another look at the house to give you an idea of how compact it is:

It's perfectly sized for one person though, and very roomy by Tanzanian standards. In any case, I can't complain since my next-door neighbors live in a one-room house made out of mud.

I'm looking forward to the World Cup, though it's getting surprisingly little attention in such a soccer-loving country. It seems like most people around here only care about the Premier League. When I asked a friend which team he favored for the World Cup, he answered Manchester United. When I informed him that, since they weren't a national team, they wouldn't be playing, he just said, "Huh."

I read on the Internet that smart watches are starting to be a thing in the US. Well, here in Tanzania we are way ahead of the game.

Dog-throat-scopy

I got to witness an interesting procedure.

One of Dr. Frank and Susan's dogs, Safi, had been feeling poorly, and an online veterinary consult suggested she might have throat worms. This is a potentially life-threatening condition since they can migrate to the heart and cause cardiac failure. The nearest vet is in Arusha, and charges an arm and a leg, so Dr. Frank got his longest laparoscope and went to take a look himself.

I happened to wander by at the right time, and got a chance to help out by holding the dog in place and switching the scope on and off to keep it from overheating.

Here's the patient before the procedure.

Our nurse had no problem finding a vein on her, and she was very calm when they put the IV in.


She did get very confused though, when her hind legs stopped working.




We used a big vacuum splint to hold the anesthetized dog upside down during the procedure.











It was interesting to watch Dr. Frank intubate the dog. I had done intubation on dummies because, contrary to all good sense, it used to be part of the Ohio EMT-Basic scope of practice. I had never had the chance to actually visualize the glottic opening on a living, breathing creature before, and Dr. Frank let me take a look with the laryngoscope. It turns out that big dogs are easy to tube because they have great big vocal chords, and they don't have the 90 degree bend between mouth and trachea.

The problem was that big dogs also make a lot of slobber, and they had to suction out about a liter of spit before Dr. Frank could see anything in the esophagus.

Our nurses are used to Dr. Frank's devotion to his dogs, but we got some funny looks from everyone else. There are lots of dogs around Karatu, but they have a very different relationship with people here than in the US. They aren't pets so much as part of the scenery, like litter. Some people keep them in their compounds, but they typically lock them up in little boxes during the day, and nobody pets a dog. I suppose it's a reasonable attitude to have where there are so many stray dogs, and none of them have rabies vaccinations.

In other news, we are starting into the long rains. Our big, 5000 liter tank was almost full yesterday, and this morning the iron stand it sits on collapsed. The tank fell on its side, demolishing a section of the security wall behind it. I took a closer look at the welds on the broken stand, and none of them were worth a nickel. It was a good thing nobody was standing next to tank this morning.

Piki Piki Trip

When I get a chance to take a day off, I usually jump on the dirtbike and head off into the bush. My first trip was to Lake Eyasi, a big salt flat and soda lake about three hours away.

Last Tuesday, I went to Mbulu Mbulu, an area right on the edge of the escarpment of the central African rift. My friend Sokoine, who also works at FAME, wanted to come along too, so we had the experience of traveling with two guys on one little motorcycle on some very steep, rough tracks. We spent a lot of time in first gear at full throttle and just had to push the bike over a few of the rockier or muddier sections of trail.

The countryside was beautiful though: little farms squeezed between the Ngorongoro wilderness and the 1,500 foot drop off of the escarpment with the empty Maasai steppe beyond. We also caught a glimpse of the Oldonyo Langai volcano in the distance.

I had been in the area before when I tagged along on a mobile neurology clinic. I didn't pack a lunch because I knew a place where you could get peanuts and cookies in a little town along the way. However, Sokoine was confident that we could find peanuts at our destination, a little town at the very end of the inhabited zone along the cliff top. So we drove right by the first shop, giving a bird-in-the-hand to the wind.

We also stopped to help a man who had gotten his motorcycle stuck. It was weighed down with bags of grain, and there was no way he could get it out of the rocks by himself. After we heaved his bike back onto the path, he confirmed the presence of a store in the next community, so off we went.

There was indeed a store (read mud hut with a sign), but all they could offer us was one, dust-covered bottle of Coca-Cola. So we gave up on the peanuts, left the motorcycle at the house of a Maasai lady (Sokoine is also Maasai, and he assured me that any property we left with another Maasai would be safer than in a bank vault) and climbed the tallest hill in the area on foot to get a good look around. It was a steep, 30 minute climb, but there we found company on top because it's the only place in the area where you can get cell phone reception.

Sokoine took pictures, but he couldn't get the hang of holding the camera straight.

When we went back down, it turned out that the house we left the bike and helmets at belonged to the same guy we helped with the motorcycle earlier and he had come home for lunch. So he invited us to eat with him, corn-chowder and fresh milk, so it turned out we didn't need peanuts after all. I might have also agreed to buy 10 kilos of dried beans from him, but I'm not sure.

Sokoine's son, Ibra, also shows great promise as a future motorcycle adventurer. He will be turning one next month, but he already knows how to make motorcycle noises, and he loves to wear my helmet.

















BONUS EMERGENCY MEDICINE PHOTO

We had someone show up at the clinic today in a motorcycle ambulance, generously donated to the local government hospital by the government of Saudi Arabia.

Serengeti

One or our volunteer docs invited me along on a trip to the Serengeti National Park.

They were traveling with a "budget" operator, which still means a private vehicle, driver/guide and a cook. My preferred way of experiencing wilderness is on foot with a pack on my back and a good topo map. The idea of paying hundreds of dollars per day to be chauffeured around and have someone else set up your tent for you is not my typical idea of fun. However, the places we went were so incredible that I just didn't care. Would I do it again? No. Was it worth every penny? Absolutely.

We went through the Ngorongoro crater first, truly one of the geological wonders of the world. It was such a lovely place that I completely forgot about my camera until afterward. I will try to get some of the panorama shots from the folks I was traveling with to post. I did pull out my camera to take a picture of this lion though.

Good times.

Here's an elephant too.

Rain rain

I bought a little 125cc motorcycle.

The plan is to putter around to see the sights that are out of walking distance. This part of Tanzania is really geared for high-dollar tourism, which I frankly can't afford. Instead, I'll try to see the lesser known, and free things that only a few hours of puttering down dirt tracks can afford.

It's a little, cheap Chinese knock-off of a Honda design. As long as it runs for a year or two and I can keep up with all the little pieces falling off, I will consider it a win. The day I bought it, when I got back to the clinic and unloaded it from the pickup truck. I found a chameleon climbing on the front spokes. I have wanted to see one of these critters since I got here, so I will consider it a good sign.

So far the only problem (aside from little plastic bits breaking off) is that the exhaust is very loud. If anyone has cheap and easy suggestions for reducing the noise, I would love to hear them.

Oh, and it has rained every day since I bought the thing, so I haven't been able to ride it once. The mud here is unbelievably slippery, so I refuse to ride unless it is absolutely dry, as per Safe Motorcycling Rule #3: "Don't drive in mud."

The first trip I want to make is out to Lake Eyasi, the closest thing that passes for wilderness out here that you don't have to pay to get into. I went there the other day with a group of doctors who toured FAME and then offered to let me tag along on a visit to the Hadzabe bushmen who live in the area. I'm normally not into cultural tourism, but I wanted to see the area, so I went. It was actually kind of fun. The Hadzabe had a little routine that they did for tourists, walking through the scrublands, pointing out pretty birds and subsequently shooting and eating them, making fire via friction, shooting arrows, songs, dancing and a gift shop. We got there in the late afternoon and all men were just sitting around smoking marijuana or idly kicking one of their dogs. I wonder how much the flow of money from tourism has changed their lifestyle. I snapped a picture of the group of doctor-tourists watching the bushman in his element.

I also learned on that trip that the Japanese are by far the best at being tourists. We had three Japanese doctors in the group, and they were all super-interested in the cultural tour, they got their pictures taken with the little Hadzabe kids, they all wanted to try out the bow and arrow, and they jumped right in with the circle dancing. I think they had twice as good a time as any of the Germans who stood stiffly around and watched.

Meanwhile back at work, my office is filled with electronics and random pieces of medical equipment to be fixed, evaluated or thrown away. Dr. Frank is cleaning out his office, which means that he puts things in boxes and moves them to my office.

It's not as bad as it has been. When we have lot's of volunteers, the technical support duties escalate rapidly. Here is a typical day from last November:

Also, this morning I saw a couple of little frogs sitting in the flower garden. It would have made a great picture, but all the photographic equipment I had was the little camera on my phone. (Incidentally all but one of the photos in this post were shot on that phone.) I did my best, but I was wishing for anything with better focusing and resolution.

Market Day

Twice a month, a whirlwind of commercial chaos descends on Karatu: Market Day. (Mnada in Swahili.) Anyone who has anything to sell in a forty kilometer radius meets up in the big empty field and transforms it into a giant, writhing mass of cut-throat bartering. Need a goat? We have hundreds! Clothes? Baskets? Trinkets? Pineapples? A stove? A bedroom set? No problem.

When I drive a car there and park next to the entrance, I get swarmed before I can open the door. Hawkers of tourist goods (bracelets, jerseys, carvings and the like) can spot a white person at 500 meters despite the crowds and cover that distance in nothing flat. I've learned to either walk or to park the car behind the goat trading section, where none of tourist-hunters go.

Even my broken Swahili works well on Market Day. People are amazingly good at understanding you when they are trying to sell you something.

We have a new doctor from the UK, so I took her down there today, just to experience the atmosphere. I spent most of the time there fending off eager bracelet vendors who had zeroed in on Dr. Jo, but I still found time to pick up a nice leather jacket. $4 well spent.

Speaking of high fashion, here is a picture of Dr. Frank's surgical getup after an operation last week:

We had nine surgeries in the first nine days after the OR opened. Our visiting general surgeon, Dr. Duane, was seeing patients right up to when we had to practically frog-march him to the car, so that he wasn't late on his way to the airport.

BONUS PICTURE: Here is a gratuitous elephant picture we took next to the main highway on a trip to Arusha.