High Tech

Just because Tanzania is a developing country doesn't mean we can't use technology. It's just harder.

No piece of technology more advanced than an inclined plane works as billed in this environment. You have to fight for every functional moment. Examples:

Dr. Joyce brought a conductivity meter to test distilled water. The machine came from a reputable firm, was factory calibrated, and arrived new in the box. Doesn't work.

We set up Dr. Frank's simple and reliable battery charger to do some electrolysis rust removal. Very basic setup: water, washing soda iron cathode, iron anode, solid electrical connections. Doesn't work.

I bought a brand new, light-up watch in the market. Doesn't work.

Backup Internet modem... doesn't work.

Lamination machine... doesn't work.

Microscope camera...doesn't work.

To cap it all, we have a long succession of failed hard drives.

One of the major problems is dust. Karatu is dusty all year except for the rainy seasons, when it's muddy. A big chunk of our most delicate, and expensive, equipment is located in a special room in the laboratory. This room is one of three on campus equipped with an air conditioner (the other two being the operating rooms). Last time we had a massive dust storm blast through, the windows were left wide open. Why? The lab techs said the air from the air conditioner was too dry, and it gave them a headache. Dr. Joyce (one of our lab volunteers) was ready to pull her hair out.

The most recent problem is ants. They live in the rafters and come trooping down every day to eat the serum that gets tested in the diagnostic equipment. Dr. Joyce has one of the techs clean the wall twice a day with bleach to disrupt their navigation, but still they come.

Every day the techs go forth to combat an unrelenting onslaught of swirling dust and swarming ants. Except for today, since it's pretty nice out. But usually...

In some ways, though, Tanzania is far more advanced. Even in largely developed countries, like the US, we don't have anything nearly as high tech as laser ketchup.

PS I have started shucking and roasting the coffee I brought back from Kessy's house at Kilimanjaro. Early attempts have yielded mixed results, but I continue forward, undaunted.

Problem #7

When it rains, it pours.

The new surgical wing means that soon we will be able to do emergency C-sections, and that means we are on our way to providing labor and delivery services.

This means that we need a room to do it in. We have a room picked out, and a special bed on order, but the problem is that the room is right next to all the other patient rooms in the ward. This may lead to some unfortunate noise issues.

So my new challenge is to find a way to soundproof the delivery room using locally sourced materials and little to no money. The other issue is that my boss, Mama Susan, wants it to be an aesthetically pleasing space inside and out. It's a fairly large room, with two exterior walls, two windows, an inclosed bathroom, and a double door to the ward.

My resources are:
1. Me
2. probably up to $100 or so
3. a crew of groundsmen with extensive carpentry skills
4. a car (for fetching supplies)

I'm open to suggestions.

UPDATE microscope problem
It turns out that there is a problem with the camera itself, which I cannot fix. So I am trying to get the manufacturer, Olympus, to take it back for repairs. They aren't returning my emails or answering their phones so far though.

In the meantime, we are pursuing the stopgap measure of adapting a different camera. I already wrote about trying the point and shoot option. This has not produced very satisfactory results.

Thanks to Vickie suggesting phone cameras. As outlandish as it might sound, this may be a viable option. Thanks to Nathan for telling me about Skylight, a product that lets you take pictures with recent model iPhones through the microscope eyepiece. I've been in touch with them, and they agreed to donate a skylight for FAME. I hope we can work it out to arrive before the end of December. That just leaves the problem of finding a an appropriate iPhone. Mine is first generation, and it has very limited photographic capabilities. We really want a 4S or later model, and I thought that Dr. Frank had a stockpile of them somewhere, but it turns out that all of his are older models too.

UPDATE gym equipment problem
I finally got around to pouring my concrete weights. Below is a picture of one of them in the frame:

I borrowed some leftover bricks from the new volunteer bungalow, and built a fairly creditable bench as well. As soon as my shoulder gets better (I'm having some rotator cuff tendonitis issues), it will be ready to go.

Coffee, surgery and banana beer

Things remain interesting.

Our surgical ward is soon to be opened! Soon we will be able to do life-saving procedures here instead of referring them to Arusha-- some three hours' drive away.

The only downside is that the offices had to be reshuffled to clear out the surgical ward, and consequently I got booted from my nice big office to my new closet. This was not unexpected. When the most junior, least important staff member has the nicest office on campus, it's not a stable situation.

Old Office

New Office

 In other news, I just got back from a trip to Kongo, a little village on the slopes of Mt. Kilimanjaro. A friend of mine (who stays in the same house in town), has four weeks off work (he's a teacher), and he invited me to come meet his family. One five-hour bus ride, one one-hour dala dala ride (mini-bus), one boda boda (motorcycle taxi) ride, and one half hour walk later, we arrived.

Kongo and its environs are everything that I expected of equitorial Africa-- small villages clumped on steep tropical slopes, banana and coffee cultivation, everything green except the red soil.

I had a great time, and actually managed to take a few pictures too.

Here is a view of the landscape around Kongo.

Here is one of myself, my friend Kessy and his faithful steed-- the piki piki (motorcycle).

I also got a chance to learn about making coffee. It's one of the main cash crops in the area. I got some practical experience with every step of the process from planting to drinking. I knew surprisingly little about where coffee came from before. It turns out that the fruit is pretty tasty all by itself.

Here are some coffee beans in different stages of the coffee making process. From left to right, unripe fruit, ripe fruit, extracted beans, dried beans. The ones on the far right are ready for roasting.

I also learned about banana beer, the local home-made alcohol of choice. I had tried Karatu's local brew--millet beer-- on market days. That stuff tastes like someone ate a bowl of gruel, chugged a bottle of vodka and then vomited it back into your cup. Proper etiquette for drinking millet beer involves blowing the mold on the surface away from the edge of the cup before you drink. They serve it in giant plastic mugs that probably haven't been washed since they left the factory, and the men imbibe gallons of the stuff.

The banana beer on the other hand isn't so bad. It has a sweet flavor and not nearly so much mold.

Here is Kessy with a generous ration.

The hospitality I found at Kessy's house was very nice. The whole family was extremely welcoming, interested in teaching me about Tanzania, and interested in learning about America as well.

Here is the whole household together.

They sent me off with a kilo of coffee and an invitation to return. Then Kessy saw me to the bus station in Moshi, where we encountered a terrible choice.

I had brought a really excellent novel for the trip: The White Tiger by Aravind Adiga. It was so good, I finished it on the trip there and had nothing to read on the way back. Fortunately there was a book store close to the bus stop. Unfortunately, the only English offerings were this...

  or this...

I'm sorry to say I made a horrible mistake. Next time I'll learn about juicing.

Quick thoughts

I don't have much time to write, so here are some quick notes.

1. People here wave with both hands, but they don't actually wave their hands. They wave at you by putting both arms in the air like freeze-frame jazz hands.

2. Squat toilet pro tip-- take your phone out of your pocket first.

3. There is always a rainbow and always a giraffe. If you don't see them, you just aren't looking hard enough.

4. I have a new project: trying to soundproof the future labor and delivery room. Women should be able to scream if they want to, but we don't want the other patients getting the wrong idea.

5. For some reason, a lot of people (mostly tourists on vacation) bring toothbrushes to donate to us. You can buy toothbrushes everywhere in Tanzania, and they only cost 500/- (about thirty cents). Why don't people bring things we actually need, like ant traps?

6. Our laboratory is under attack. The ants like the serum that gets tested in the lab equipment, and it's a constant struggle to keep our most delicate (and expensive) equipment protected.

Hope to have more time to write and post pictures tomorrow.

Short Rains

The short rainy season has officially begun.

It started with a blast of rain and a plague of frogs. The rain lasted 15 minutes, the frogs for two days. I don't know where the frogs all came from. Hundreds of thousands of them appeared seemingly from nowhere. The kids chased them across the backyard. They hopped over everything, onto the porch, into the hall, across the road. Thousands upon thousands tried to cross the paved highway in a terrible, mass act of amphibian suicide.

In two days, they had all gone, disappeared back to wherever they came from.

A week later we got a second storm. It was raining barrels. I woke up at 5:00am to the strangest sound. At first I thought someone was running a big engine, but then I realized it was rain. Buckets and buckets of it. Mama roused out all the girls (at 5:00am mind you) to clean off the concrete patio while the water lasted. This was followed by a plague of termites.

In a rush. Will post pictures tomorrow.

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.