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.