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.