Radio Furaha and Idete Dispensary

I spent last night at the Lutheran Center so I could be here in the afternoon for a meeting with Joan Mayer from USAID and be ready this morning for the Radio Furaha broadcast about nutrition and breastfeeding.  Joan had to cancel.  So I had a nice dinner with the Como Park group.  There was a rousing discussion on many topics and all left as friends.  It is so stimulating to hear many thoughtful perspectives, all right in so many different ways.

This morning started bright and early with me waking up just after 5 AM.  I reviewed the material I wanted to cover and had a little breakfast.  The Radio Furaha studio is inside the gates at DIRA.  The manager is Protas Kanamela.  I don’t know if he is on air anymore, but he definitely has a great voice for it.

The studio room is very quiet.  Two radio jockeys broadcast the morning show, also with great voices.  There is a desk with lots of equipment and a computer and very official looking radio gear.  For the call-ins, they cover a cell phone with a foam damper, like the kind we see on the microphones.  Well, the other stuff looks official.  But no more effective that this innovation!  To get to the sound booth, you enter through an anteroom.  Shoes are removed outside.  My friend Maria Biswalo was there to assist me.  She is Tanzanian whose early schooling was at a boarding school where all the kids spoke German.  (Her husband is the son of our German friend Beate Mundt.) She spent another four years in the US at University of New Orleans.  She speaks English with no accent.  It was great to have her help!  We talked about nutrition and breastfeeding and then answered call-in questions.  As far as I am concerned it went well.  But then, how would I know?  Although, I think Maria would have been kind enough to tell me if they were talking about the weather in, say, Minnesota.  Apparently it was live-streamed over the internet.  I may never know that for sure either, unless some English speaker who knows me actually tuned in.  The gang from Como Park tried to catch it on the internet but were unsuccessful.

From the road overlooking a valley near Idete

When I finished with the radio show, Dr. Saga and the students were waiting for me.  We bustled off to Idete in two vehicles.  The old Land Cruisers are quite serviceable, but may be of a vintage prior to shocks and springs.  It is a much shorter trip than to Idunda and only 15,000 bumps were recorded by my FitBit.  Idunda is a 25,000 bump trip.  Of course that is both ways.  One of the students tells me there is an app (of course there is) that turns off counting when you are in a vehicle.  No way, Jose!  I earned those bumps too.

The old ward

We brought a bunch of medicines to Idete purchased by Randy Hurley (and possibly SOTV).  We had a little tea.  But not just tea; actually, tea, chicken, potatoes, vegetables and assorted sodas.  Never just tea!  This is Tanzania where hospitality, relationships and generosity reign supreme, immediately under religion.

Labor bed in the old ward

The dispensary at Idete is extremely nice.  I was there in August with the Lake Park folks when they delivered a lot of new equipment, supplies and medicines.  Many doors are narrow in Tanzania.  We had trouble getting all of the beds into the wards, especially the two-ton Tilly of a maternity bed.  The only thing we could do was to tip it on its side and scrape it through.  Thankfully, nothing broke off.  For most doors, the width doesn’t matter much.  Tanzanians themselves mostly aren’t very wide.   But I hope the builders follow our suggestion of putting a narrow stationary side door along side the entry so we can get beds and stretchers in and out when necessary. 

Idete Clinic

Dr. Saga and I spent a lot of time going over the new plans and even then we forgot something that others noticed immediately.  (This would be “the forest for the trees” syndrome, I think.)

They should be extremely proud of the Idete Dispensary, the doors not withstanding.  They started with a couple of huts for labor rooms or ward beds.  You see the photo!  Then they constructed the old one, still serviceable.  The new digs are terrific.  The maternity ward has two delivery beds and an exam table and an indoor choo.  Outside they have a choo building with 5 or six in a line.  There is a recovery room attached to the labor room.  I might add that the door has a stationary side door that opens to widen the space to accommodate the delivery bed.   Two more wards for males and females allow plenty of growth.

The new dispensary

While our pharmacy students restocked the shelves with the medicines, Chandra, Deepthi and Cole saw a few patients, including a spry 90 year-old with knee problems, a 75 year-old with cough, probably TB and a baby with a stooling problem.  (Well, yes, I was there too).

Our Crew: Astrid, Cole,Chandra, Deepthi, Shana, Tuli, Kelsey and Dr. Saga

After a few photos, we headed out.  Now we will head back to Ilula after a couple hours in Iringa.  The students thought the drive to Idete was beautiful.  Of course I agree, but I do have a bias.  It was nice to be home after a successful outing.  And the rain held off.

Water?

Maybe tomorrow.  A piece was supposed to arrive from Dar tomorrow, but I have no idea how long between now and it is installed and working properly.  This is always an “iffy” proposition.  I am not sure which “fundi” (mechanic/technician/craftsman) will put it together.  It cannot happen soon enough, of course.

It did rain the past two days.  Neither was a taunt like the day before.  We had a gully-washer yesterday and as Cole said, the buckets filled in five minutes.  The 1.5 liter bottles filled in about 5 seconds.  Really.  So we have had nice soft rainwater for showers and washing.

Our little peanut of 34 weeks gestation is now a week old.  The baby is now over the hump for birth-related infection and has survived long enough so the lungs are no longer a problem.  However, mother’s milk is not in and if it does not come in, the baby will die.  We have started to push her to drink fluids, in hope that will help.  We will see.

Dr. Leslie Pratt will assist (or do) a C-section tomorrow for twins.  It is risky waiting much more.  I am not sure of the due date, but apparently they are confident she is far enough along.  I think there was a hint of BP elevation, so this is the reason not to wait.

Our boy with marasmus is still here, but the doctor wanted to discharge him.  We asked him not to, because of the high risk of rapid relapse.  We are trying to set up Home Based Care through Amani Orphans Home Mbigili.  The child needs monitoring and balanced FOOD, not only ugali.

Mary Thompson and Dede Ouren have been diligent about work on Premature Rupture of Membranes (PROM).  In September, I worked with Dr. Rite on a checklist, but it was not implemented.  Now there is a new edition of Standard Treatment Guidelines for Tanzania.  The medicines are just a bit different than we had put in the data prompt tool.  So I rewrote it.  Tomorrow I will present it to the medical staff and hope for buy in.  The OB nurses are already on board, I think.  Dr. Rite suggested we put it in every chart and ask the delivering doctor to circle the answers on the checklist.  Couldn’t be easier, right?  We will see.  This would be an opportunity for them to get a paper published possibly.  Again, we will see.

All our students are terrific, devoted and smart.  We are having a good time.  Chandra, our third year FP resident is a real star.  He is smart and inquisitive and so knowledgeable!

Tonight we had a movie night and watched Elysium.  All enjoyed it.  I could refine the system a bit with a dedicated extension and plugs, but we make do.  I would like an even better speaker than my excellent tiny Boomz.

As you can see, water or no, we are surviving well.

Ground Hog’s Day

Certainly the Ground Hog saw its shadow here in Tanzania!  It began bright and sunny here, although it is now threatening to rain on our parade, I mean drying clothes.  I think it is a bluff.  Several times in the past two weeks we have seen this pattern only to watch it blow over.  We have had no significant rain since the Hurleys left.  I blame Randy.  Of course it has been rather nice, however we really do depend on rain right now for water.

I cannot remember if I waxed philosophic or prosaically on the water situation: there is none.  That is to say, the water system has been broken for several months, in fact, since Birdie and I were here in September, possibly before.  So I have felt quite chagrined to find this out on arrival.  I toured the nursing school with Dr. Saga, Mwamoody and Mchungaji Lamont just before leaving at the end of September.  We knew the water supply was having trouble.  We had no idea of the extent to which the well had failed.  It was not simply the leaky pipe we saw.

So this means the Ilula Lutheran District Hospital has been without a reliable water supply for four months.  On arrival January 6^th and discovery of the problem, Dr. Moody consulted with Shoulder to Shoulder to fix what needed to be fixed (about $4,000). In February.  Well it’s February and it isn’t fixed.  OK, I acknowledge that it isn’t very far into February.  OK, also that today is a Sunday.  However, can you imagine a hospital without running water?  We have had water carried in for nearly two weeks.  At 500 TZS per 20 liters, it is pretty expensive to do this.  We conserve as best we can.  I can shower with less than 1.5 liters of water.  Carl Sherman, thanks.  Two years ago Carl put several holes in the plastic bottle caps for each of us making a very efficient shower vessel. 

The town’s water supply is no better.  Apparently it failed also but not necessarily at the same time.  When it was running, Ilula still got only a trickle; hence its own well and pump.

Oh, and it just rained for nearly 5 minutes.  This does not count.  I think we collected a total of 5 gallons.  “In a real rain, we could collect over 50 gallons in 5 minutes,” Cole explained, experienced from before we came.  So, this one was only a taunt.  Still looks promising for more, but my challenge holds until then.

Dr. Jill (Stebbins) and I did Maternal-Child rounds this AM.  I was not exactly useless (perhaps “useless” is a little too self-deprecating), but she carried the ball, in part because I bailed to do a couple other things. 

In this ward are the post C-section moms and their babies.  If they live close, they can leave on Post Partum Day #3 (PPD) and return PPD #7 for suture removal.  If distant to ILH, they stay until PPD #7 and have their sutures removed then and home.  Today we saw a 16 year-old mother and her baby.  It happens here too, just like at home.  She is doing well physically.  I do not know if there is a baba (baby’s father) in the picture.  Also saw a mom whose milk has not come in, so baby is a little disinterested.  Dr. Furaha did an excellent job of helping her.  Left breast seemed a little awkward and a bit dry.  He switched her to the right and with a little more expression of the nipple got some milk.  This little boy knows the good stuff!  Maybe all the suckling stimulated a little let down to help out, but not before this concerned new mom shed a few tears.  She looked much happier when the baby was latched on.

In the nursery is a newborn a few days old now, born at 32 weeks gestation.  So far this little peanut is doing well.  She is breathing well and has good muscle tone when stimulated.  Since virtually all of the moms do round-the-clock care, there isn’t much need for the bassinets.  However, also there are two simple but elegant warmers with fluorescent bili lights and incandescent warmers.  However, I learned a couple months ago that even the special blue fluorescent lights (these have standard fluorescents) must be within a specific distance or they do no good.  Unless the placebo effect on the medical staff somehow helps the baby, but I doubt it.  This will be something we can repair easily!  Thank you Kiwanis Netherlands!

 

Oh.  And the storm blew over.  No more rain.

Fast and furious, Tanzania style

Things have been fast and furious here, in a Tanzania sort of way.  I now have a modem, which allows me to post to the blog.  At least as I have energy to do so.  Since there has been much water under the bridge since we arrived a week ago, I have much to recall.

This is likely to be a chronological mess, so dear readers, just understand that it has all happened in one week.  From the perspective of geological time,  it would appear as an instant anyway.

When we arrived, we learned that tragedy had struck the family of one of our team.  Randy and Kari informed us that the brother of one of our students, Sandy Lee, suffered serious injury in Afghanistan.  He is a medic in the Minnesota National Guard.  He was seriously injured by an IED.  Consequently, he was air-lifted to Germany and then flown to Walter Reed in Washington, DC.  He suffered multiple life threatening injuries.  I believe he is stable now.  Sandy was able to arrange travel to join him Saturday morning.  MwaMoody, Dr. Kvasnicka and Pastor Lamont Koerner have shepherded Sandy home.

We are not without local tragedy surrounding us either.  One bad car accident took two victims, one of Dr. Saga’s relatives (half-cousin) and a pastor’s wife, when the car’s brakes failed.  Another car wreck put at least two people in the hospital here and one of them needed to be transferred to Iringa.

We lost a three-month old and several other patients for various reasons.  This how life is in Tanzania.

A child with marasmus is slightly better, but mama wanted to take him home.  Care is free to children under five but he is six.  Atu, one of our dear ILH nurses intervened and has arranged a week of a free bed with the hospital.  Then we hope he is stronger with good diet and can be discharged to Home-Based Care coordinated with Amani Orphan’s Home Mbigili (AOHM).  They are calling me Dr. Plumpy’Nut, which is fine, just not Dr. Plumpy, however apt.  The supply of P’N has been interrupted, but will resume with the next distribution.

We went to AOHM just after lunch and examined a few kids and an adult.  I value their trust and appreciate being asked, which does not mean I am fully confident of the diagnoses.  Hey!  There are exotic things in Africa!  But also some very familiar things too.  The baby I saw a few days ago, Tuesday if I remember correctly, is better.  Whew!  I always appreciate nature doing her thing.

Late this afternoon we had a big celebration for three retiring staff people, including Dr. Saga.  We thought it was supposed to be at two, then three, then four.  It started at 5 PM sharp (ha!).  It was delayed in part due to a funeral for one of the car accident victims, then the ILH board meeting which went on and on (and on).  Eventually the meeting was over and the dignitaries were all here.  Dr. Saga, Mama Sanga and Eliza Mtweve were all dressed up.  Dr. Saga looked sharp in his black suit, white shirt and red tie.  There was singing and speeches, clapping and celebrating.  I was honored to speak just a little about Dr. Saga.  It was a joy to do so, if not perfect.  The audience did laugh at the appropriate times, but we wazungu are worth laughing at anytime anyway.  They really know how to throw a big shindig! 

We miss Dora Saga.  I know Dr. Saga misses her terribly.  With her absence, the was much laughter about finding a new wife for Dr. Saga.  He is definitely the most eligible bachelor in town and likely all of the Kilolo district and Iringa Diocese!

It is just after 11 PM here now.  We had our second movie night and finished about half hour ago.  In the morning we will take the bus to Iringa, catch up with Dennis Ngede and I hope get a vehicle and driver to take the group to Isimila. Our dear friend, Tuli Hingi, will accompany us to Iringa.  We all love having her.

So, that is it for now.  I will see if I can upload this!

In Iringa today

After a very successful Ilula International Medical Conference, the pharmacy students including myself, are in Iringa to learn more about the distribution of medications in Tanzania. In particular, the MSD distribution center. It is governement run and supplies hospitals wth medications and supplies at a lower cost.

Also, we will be on the radio in the morning.

Will update on that later. :)

The conference
I have added a picture of Tully, a nurse at Ilula Hospital,  teaching others about newborn resuscitation.

In addition, I added a photo of one of our presenters. I apologize for the quality of the photos as they were taken with my tablet from far, but soon we will be able to upload our photos from our cameras.

Two Weeks Later. ..

Hi everyone,
I have updated a previous post due to some missing sentences about my expectations for Tanzania before we left.

Someone shared the following link. I think you will enjoy it.

"Our lives, our cultures, are composed of many overlapping stories. Novelist Chimamanda Adichie tells the story of how she found her authentic cultural voice -- and warns that if we hear only a single story about another person or country, we risk a critical misunderstanding."

http://www.ted.com/talks/chimamanda_adichie_the_danger_of_a_single_story.html

Thursday in AMS

Well, here we are.  No problems with the flight at all.  John Kvasnicka has just joined us in Amsterdam, Schiphol Airport.  I think it is pronounced close to ski-pole.  We didn’t sleep on the plane.  After all, it is only about midnight or so to our bodies, despite the clock here saying 8:30 AM.

We should start the boarding in about half an hour.  The personnel are arriving already.  Quite a few people waiting now.  Lots of American accents in this general waiting area.  Our flight leaves AMS at 10:15.

We are all excited if somewhat weary.  It is always a surprise as to who will be meeting us at the airport.

More soon, I hope.  We will see if we can connect a few times or not!