Our new home

I apologize for taking so long to get this next post completed. It has been a busy week as we finally moved into our new home on the Kilema Hospital Compound. It is a nice little house that is overlooking a valley with Kilimanjaro behind us. We have banana trees in front and a pig pen behind (well, about 20 feet behind but it sure sounds like they are on our back step. Their lovely odour wafts through the house at different times of the day as the wind shifts. The sow and her piglets make a huge racket that sounds like a scene from Jurassic Park. It usually happens about every three hours or so as the piglets go in for their next meal. She is not a happy camper when this happens...and who can blame her!
The floor is concrete but polished and smooth. We have only cold water at present but purchased the tank on Monday and hope to have the hot water installed soon. Hannah cries very time we have to take a shower. Roman and Jack do a lot of yelling as well to try to get through it. We have a two burner electric hot plate and a small fridge. We have three bedrooms and each bed has a mosquito net. The windows have screens but somehow the bugs just seem to make it in. We are quite settled and happy in its simplicity. The bird sounds in the morning are incredible and I love to sit on our little porch in the morning and look out over the valley. The pigs and the church bells have been waking us up rather early. Jack is in a routine now with the school work we brought and is back practicing violin. The house up the hill next to us belongs to the local doctor and he has two children, Jackson (10) and Yeska (6). The speak no Engligh and my kids speak no Swahili but everyone seems to manage quite well. There is always a lot of giggling going on. Hannah tends to boss them around (although I don't think they know it), 'come Yeska, sit here, no , sit over here, here is the yellow pencil crayon, you can use this one". Yeska smiles and tries to carry out the orders as best she can. Pictures to follow soon. The new Canadian caravaners arrived on Sunday evening and we have three docs, a nurse and a logistics person in our house (so Roman and the kids and I are all in one room in two beds) as well until March 11th. They are great company and we have had a lot of laughs, Patrick Falloon is a chiropractor who worked next to me yesterday at the dispensary and the patients just loved him. I don't think they had ever been 'touched' that way before. The Smile-O -Meter was really high all day yesterday at our first clinic day with this group. I saw quite a bit of suspected HIV and referred a bunch of people for counselling. There was quite a bit of tropical medicine and the rest of the stuff was similar to the first caravan, with sick babies, abdo pain, rashes etc. Yes, for all you who think you might have read incorrectly, I am seeing babies!! And, doing a lot of cuddling.
We will be quite busy until the 9th of March when this group packs up and then things should hopefully get back to 'normal'. Jack and Hannah will participate in two upcoming orphan days where the groups (about 250 in one and 100 in the other) come to the hospital grounds for food, games, clothing, medical care etc. I am not really sure what they will think of the whole thing but I am sure they will remember it for a long time. The plan is for Roman and Jack to participate in some home visits in late March and April when they will deliver clothes and bedding to the villages (way in the bush) to the huts where some of these children live. They will go with the local home-based care workers who are supported, in part through CACHA's orphan program. Jack seems to be processing everything in his own mostly positive way.
More to come in a few days on how this caravan has run and any interesting cases for all you docs who are reading).
Thanks to all of you who have posted comments. It is nice to hear from you! (Yes, Allison it worked!).
Take care.

Zanzibar Island

After meeting Malinga we travelled the next day by ferry (NEVER DO THIS IF YOU CAN HELP IT) to Zanzibar Island for a few days of post-medical caravan rest with Jenn and Chris. It is a unique place that was once an Omani colony. Zanzibar and Tanganyika joined together about 60 years ago to become Tanzania. It is 85% Muslim and the port city of Stone Town really reflects this. Stone Town is famous for its carved wooden doors that really look like something out of the Middle East. They are exquisitely beautiful. The most famous (or infamous) stories of Stone town are around the slave trade. Tanzania was the 'exit point' for almost all the slaves who left Africa at the height of the slave trade. Slaves would be captured in other parts of Africa (Malawi, Zambia, Congo, Burundi, Uganda...essentially all the countries that border Tanzania) and forced to walk (yes, walk) to the ports in Bagamoyo and Dar es Salaam. They would then be taken by boat to Zanzibar Island and traded by our white, evil, colonialist ancestors. The slaves were 'kept' in underground caverns where a dark dingy stone room that could comfortably fit 15-20 would hold not less than 75 slaves. Many suffocated or died of dehydration. The heat in Zanzibar was like nothing I have ever felt. It is very close to the equator and very tropical. Even at the slave trade memorial site, that was in the shade, I could feel the sweat dripping off the back of my legs. The site is reasonably well preserved and pays homage to the slaves that were killed as well as those men (missionaries) who worked to abolish slavery. Dr. Livingston's memorial (of the famous " Dr. Livingston I presume") is there as well. You may remember him as the great African explorer who died at the mouth of the river Nile. He spent quite a lot of time in Tanzania and had many African friends. Just before he died he wrote letters to Britain requesting that the slave trade be ended. He unfortunately died before he got to see this happen but he is one of the men who is accredited with helping to bring the horrible practice to an end. We heard some unbelieveable stories from our guide, Mohammed. He was very well educated in the history of Zanzibar and the slave trade. He told us how women slaves were worth more than men because they could work in hard labour and prostitution AND then give birth to these babies who would also grow up to be slaves...a perfect little business if you were an evil slave owner. I will say no more about what they did to the babies when they were trying to auction slaves off and the babies cried...use your imagination.

At the site of the Anglican church that was built over the slave yards is a beautiful monument erected in 1998 (see picture of us).It shows slaves with chains on their necks in the trading pits. For such a horrible practice, and for the role that Tanzania played in it, I expected a little more int he way of manuments or memorials, but I guess they just don't really want to rememebr the whole nasty business.
Zanzibar Island is also know for its spice crop (a.k.a Spice Island). We didn't manage to take a spice tour that weekend...too hot to do with the kids who just wanted to swim...but maybe next time.
Our guide took us to our hotel where we would spend two great days. The resort was perched on the Indian Ocean. The beach was old coral reef and sand but the hotel had built a very long concrete path out to the next sandbar. During the changing tides you were able to see the aquatic life in the tidal pools. Hannah and Jack had a collection of hermit crabs going. Our room was a cottage on a cliff that was very Zanzibarian with netting around the beds and beautiful dark, carved woodwork. The kids particularly enjoyed the Masai 'security' guards who quietly circled the cottage every hour or so to be sure we were all safe. Jack befriended several of them (all in traditional Masai clothing) and one even showed jack a lion tooth he was wearing around his neck. He had killed the lion in the 1990's in the Ngorogoro Crater. Jack, has a million questions about everything...some of them should not be said in public either! Lets just say, we are working on that.
We move to Kilema Hospital tomorrow, now that the first caravan group has left. It will be nice to get settled in so that we can have things ready when the next group arrives and for when Mama Urasa comes next Wednesday for our home visit. This is required before Malinga can come to live with us as our foster child.

Meeting Malinga

It has been an eventful few days. We said goodbye to the wonderful CACHA Medical Caravan folks (we'll be taking part in the next one in one week as the new bunch of Canadians swarms in on little Kilema Hospital!) and travelled with Jenn and Chris to Dar es Salaam. They came along so they could witness Jack and Hannah meeting their new brother for the first time. We were excited and slightly nervous with what was to come. Malinga was also excited and anxiously waiting for us at the gate. I immediately noticed that his English had improved since our last visit last October. Jack and Malinga shook hands (quite formal) but were both beaming from ear to ear. I had forgotten how small he really was, or perhaps Jack has just grown so much since the fall...he really did tower over him. Hannah was her usual quiet and shy self (for the first 5 minutes!). All the other orphans gathered around and I hae to say, there was some nervous tension in the air. The kids ran inside and immediately brought out the family photos we had sent. They also produced a soccer ball, and, well, the ice was officially broken. The children and Roman and eventually our driver 'Tony' all started in on a pretty heavy duty and sweaty (plus 30 temperature) game of 'football'. Malinga held his own and Jack was in his element. The kids were great players and deftly passed the ball to each other and Jack. It was a small area so the game was pretty intense. Everyone was filthy but having a great time. Jenn soon pointed out that Hannah was holding court over on the climbing aparatus. I looked over and Hannah was sitting at the top with 4 or 5 other girls sitting below her, just listening to her ramble on. She was saying things like " my brother wears a diaper at night so he doesn't pee the bed' and other family secrets. I let her carry on as everyone seemed to be smiling and I am not sure how much the girls were understanding. She sang 'Oh Canada' (we caught it on video) which consisted of a lot of giggling and then she sang a song about a Bonhomme (en Francais of course!).

We eventually had to part ways as it was getting dark and the orphans had their evening routine and our driver needed to get home. We got some nice shots with Malinga and then he gave us a picture he had coloured. It was hard to say goodbye, but all in all, it was a great visit. I had imagined it in my head many times and it went as well as I had hoped. How fitting that soccer would be the ice-breaker between Jack and his new 'Kaka', which is brother in Swahili.

We are praying that things will go smoothly and that he will be living in Kilema with us soon. Things do not progress quickly here. There are no fax machines in the department of social welfare, or email, and the post in Tanzania is slow. I will help facilitate things by hand delivering all documents to the necessary people and trying to help the social workers communicate more easily. Still, some things in Africa cannot and will not be rushed.. we'll keep you posted.

More tales of medical caravan week #1

Our second day was at a dispensary called Karmeli. It is essentially a medical outpatient building where the local medical officers would hold clinics and see patients one or two days a week. The medical officers are not quite doctors, more at the level of our nurses in Canada (or maybe even a bit less skilled). The dispensary is run by the Catholic Diocese (essentially an outpost extension of the Kilema hospital we are based at). It was a primitive building with one toilet (it flushed!!) and running water from two sinks...I should qualify this statement by telling you that several of the dispensaries we visited this week had no running water. One of them was a rural government hospital site that I feel sad discussing. I really can only describe it as the most destitute place I have ever seen. The outpatient building had no running water (which was bad enough because our Purell hand sanitizer was confiscated at the airport by the health Canada/Customs officials because it was 'out of date'. This is ridiculous because it is not a drug that we were planning to give to patients (just for use by ourselves!) but they had their rules and stuck to them. They check all of our 'bins' of supplies very carefully. There are strict rules about bringing expired medicines to Africa...the ethics of it is murky when many of the expiry dates are set way before things become expired and millions of dollars of medical supplies are discarded every year by wealthier countries around the world. Mafua was the name of this particularly poor dispensary with no water. The people who were in line when we arrived were also clearly much poorer than at the first two caravan stops. Mafua was deeper into the mountainous regions of Kilimanjaro and much more isolated. Along with the poverty of course meant much sicker people. As logistics was setting up our work stations, I walked through the inpatient ward with sister Clarissa. Sister is the director of the Kilema Hospital. She has worked tirelessly to set up all of our clinics for the Caravan ahead of time. She also arranged for a hot lunch to be brought to each site for us each day. Our staple has been rice with some sort of meat or a vegetable curry dish. Since I have sworn off meat in Tanzania, that means rice for lunch each day. For those who know me as the carbo loving woman that I am..this is just fine. I cannot adequately describe the inpatient ward of this hospital. It was located in a small decrepid building about 500 yards from the outpatient centre and 400 yards from the 3 pit latrine toilets. We all made a pact on arrival that none of us would use the toilets in Mafua in order to prevent us picking up disease and carrying it into the clinic (where we couldn't wash our hands) or back to Kilema. This meant take a sip of water when you are thirsty but don't guzzle! Those who were desperate wandered off to look for a private bush but, even though this is a rural part of Africa, that can be hard to do. People live in the bushes on small plots with shacks erected. Each plot is called a shamba and it is usually handed down through inheritance or by marriage. You might think you are in a private spot but there is a high probability that you could turn around and see a little kid sitting in the bushes staring at your behind.
The hospital was deserted with respect to any hospital workers/nurses/doctors. There just didn't seem to be any one looking after the patients. Sister and I found a baby (?10 or 11 months) sitting on the floor in the hospital hallway. He raised his arms for me to pick him up..she clicked her tongue and said "this my friend is what the Tanzanian government hospital system provides". There was a clear difference to the infrastructure at the Kilema hospital (which is supported in part by the Catholic Diocese) and what was available for sick people in the Mafua area. Sister said she came up the week before to speak to the head nurse to arrange our details for arrival at the clinic and again there was no one to be found. The nurse was later found sitting in someone's house with her child on her lap. When you are paid the equivalent of $5.00 per day it is hard to be motivated.
The cases I saw in Mafua were in keeping with previous clinic days but with many more truly sick people in line. Chris Fisher (our lead person) went through the line-up of more than 500 people at various times of the day to usher in the sick babies and the elderly. I saw several children who had come with their 'Bibi' (grandmother) and on questioning had no parents to be found. This is a big clue for HIV infection. Two of them had high fevers (one with pussy ears and throat and the other with what I thought was Malaria). Both had several of the signature HIV associated skin rashes as well. I treated their various ailments as best as I could and highly encouraged them to come to Kilema Hospital for an HIV test. One 11 year old girl came by herself in the dirtiest dress I had ever seen. She lined up all day and when I saw her she had a fever of a 104!. She said she lived with her Bibi (grandmother) who was unable to line up with her. She clearly had HIV (tell tale rahses) and was severely malnourished. She had tonsillitis and symptoms of hookworm. I treated both with the medications I had and sister Geraldine wrote instructions for her in Swahili on a piece of paper. I gave her medicine for the fever which she took on the spot and very willingly. I gave her a Kit Kat bar I had in my bag and got a huge smile....it broke my heart to see her go. I know the outcome won't be good over the long term.
My translator that day was sister Geraldine, one of the sisters from Kilema who has some medical training. She was a joy to work with. ..and very sweet. Every time I would see someone and send them off with their prescription sheet to take to our makeshift pharmacy to pick up their medicine she would touch my arm and say "Assante" which is Thank you in Swahili. She even got very good at deciphering 'sick versus not sick' as she heard each person's story. We saw a lot of women between the ages of 30 and 60 who of course are the work-horses of Tanzania. As I have said previously, Africa survives on the backs of hard working women who cook, clean, farm, look after children and often do all this with 40 or 50 pounds of stuff on their heads. Most of their complaints were not surprisingly neck pain, back pain, and sciatica. Pain relief is about all we can provide. Jenn Carpenter, my dear friend and another doc who is travelling on the mission with us, was stationed in a room with me yesterday and we had a moment of comic relief when I heard her say to her translator, tell her that her neck and back pain is from carrying too much stuff on her head, she needs to cut down on the head carrying!! I just burst out laughing, I can't ever see myself saying this to someone anywhere else but right here.
I will download some pictures of interesting diagnoses for those of you who like that kind of stuff...I just haven't found the camera connector thing yet.
Roman and Jack and Hannah arrive at Kilimanjaro Airport tonight...I am very excited.
I am on my way today to meet with our social worker Asha. She will prepare our Tanzanian homestudy for the adoption. The caravan is on today as well but I took the day off. Roman and I will both be working for 5 days on the next one that wil take place the last week of February and first week of March. Sister Clarissa has found a 'girl' to help out whith watching the kids while we are at the caravan sites. She will keep them busy and provide their lunch etc...
The pictures I have posted are of a child with mumps and one of John Cockburn (yes, related to Canada's Bruce) treating a baby. Also a pic of Kili in the morning, taken from Moshi as I waited for the bus to go and meet the social worker.

Back to Africa

Well, it has taken me a week to post the first blog entry since returning to this amazing country.
I arrived in Tanzania at Kilimanjaro Airport on Monday night (February 5th). I was disappointed to arrive at night as I didn't get to do my 'fly-by' of Mount Kilimanjaro that was so awe inspiring on the last trip. Greg John (CACHA's man on the ground) met me at the airport and we went up to Kilema Hospital. Most of the medical mission group had already gone to bed...still getting over their jet-lag. The mission was to start the next morning, first stop Makomu Dispensary. I awoke quite early (jet-lag) and stepped out of my very rustic room to the most beautiful view of the mountain. The air is cool in the morning, maybe about 21 degrees celsius. The afternoon heat usually reaches about 30 to 33 degrees. We loaded the trucks and had a briefing and off we went....the site when we arrived was incredible. There were about 400 people lined up (remember this is 8:30am) , all in their colourful Kanga's, many with babies in their arms. We were all in panic mode...obviously the word had gotten out that the Canadian doctors were coming to do a clinic. The team worked well in setting up and we were quickly ushering people through. The heat rose as the day went on but not one person would move for fear of losing their place in line. They stood there all day. At the end of the day we had seen over 500 people. We didn't need to turn anyone away! Many of the people in line were 'well' (I am using this loosely). They really just wanted the chance to be seen by a doctor. It is their basic human right, even if they are not acutely ill. For those who were 'well', we prescribed a course of de-worming (more on that later) and gave a supply of paracetemol (like Tylenol) for their next fever (probably will be used for their next bout of malaria). Scott, one of the logistics people, who is a dynamic guy who works in upper management at McDonald's Canada aptly coined the term for describing the faces of those leaving our make-shift pharmacy area as the 'SMILE-O-METER'. The smiles on their faces after being given their drugs was unbelieveable...beaming is a better word. The meter seemed to rise in unison with the number of drugs they were taking home with them...antibiotics, anti-fungals, steroid cream for various skin rashes, BP meds, diabetic supplies. I was kissed, hugged, hand-shaken, blessed, prayed on...all day. The amazing thing was that although these beautiful people don't know it, I am getting back far more from them than I will ever be able to give. It renewed my faith in myself as a physician....I felt truly blessed to have spent the day there. I also felt a deep sadness for how little I was able to do for many of them as there is just no way to provide the care they need. Maybe someday things will improve...
More tomorrow on the next three days of clinics and pictures of what we saw.
Roman and the kids arrive tomorrow night. Jack and Hannah will meet their new brother, Malinga, on Wednesday.....I hope the meeting is successful.