Visit with Malinga

Again apologies for delays in blog posts. I have spent the last week in Kilema where the new Rotary funded satellite internet connedction is almost up and running ...but not quite. No timeline available either as a 'part' is needed for the wireless router. Anyway, I think my last entry ended with a reference to our harrowing bus ride to Dar es salaam to see Malinga. We had a wonderful three days and spoiled ourselves by staying at the Kilimanjaro Kempinski for three whole nights. Shafiq,our travel agent in Moshi booked us the resident rate, which is much more affordable than the rate for business travellers but still a splurge. We of course wanted only the best for Malinga for his first sleep-over with his new big brother (Big Kaka in Kiswahili...you can of course imagine the mileage that Jack my bodily function obsessed son has gotten out of that one!). Yes, brother is 'Kaka' in Kiswahili. Sister is Dada, and Hannah of course is referring to herself as the little Dada, but, it doesn't have the same effect. The bus ride on the Dar Express involved a hot (I am sure it was plus 35) sweaty and smelly, full bus load of people for 8 hours!!! We got on at 6:30 am and at 7:30 they gave out the bottle of Fanta or Coke and at noon we stopped for 'lunch'. Lunch was at a roadside restaurant in the middle of nowhere. There was 5- 10 minutes to eat some rice and beans quickly and use the pit latrines and run back on the bus. The buses staying on-time seems to be the only things that runs on schedule in this land of paradoxes. When it is time to leave (and no -one knows when the driver will decide that is) the driver and his assistant start to board the bus and beep the horn and roll, out fo the parking lot no matter who is missing. I am not exaggerating either. Once we arrived in Dar we cooled off our slightly stressed and over-heated kids in the beautiful infinity pool that overlooked the harbour (Indian ocean). The rooms felt like a palace after Kilema, we all slept in a fluffy King Size bed after a huge dinner. Hannah fell asleep at the table though and missed her spaghetti. The next day we had a breakfast meeting with our lawyer and Tanzanian adoption wiz...Brooke Montgomery. We asked if Malinga could stay with us that evening and she agreed it would be a good idea. We went to the orphanage when the kids returned home from school and were met by all the children and their wonderful smiles and hugs...we are getting to know them all quite well. They all have distinct little personalities as well. Malinga had been asked by the volunteer if he wanted to go with us for a 'sleepover' and according to her he smiled and didn't waste any time by marching to his room and packed his bag.
We had a truly awesome night and i was really touched by how kind and gentle my children were with him. They almost fought over who could be nicer to him. Hannah had her arm around him in the taxi and Jack took his hand as we walked into the hotel. We went for a swim first. Malinga can float, which is a start but Jack basically pulled him around on a buoy the whole time. After it got dark we went for a nice dinner. My heart was breaking as I watched him clear his plate and then Jack's leftovers. He would have had Hannah's too I think if he wasn't so tired. We went up to bed at that point. The three kids climbed under the fluffy white duvet and watched African soccer. When the room attendant arrived with Malinga's fold up cot he climbed under the covers and was sound asleep in 3 minutes. We all slept well that night...it was nice to have him so close.
The next morning, Jack and I rose early with Malinga so we could enjoy a leisurely breakfast and get him to school on time. Again, he ate three times what I thought his stomach would hold...and topped it off with a gooey chocolate donut (which he politely tried to cut with a knife and fork before I convinced him to pick it up with his fingers!). After breakfast we grabbed a taxi and took him to school. He goes to a lovely English Waldorf-based curriculum school and is in the first grade. The orphans from his orphanage are all sent there at some expense to try to get them a better education than the government system provides here...namely schooling in English and, where children are not routinely disciplined through corporal punishment. Jack was invited to participate in the rhythmic play session that they started their day with. He and Malinga were both grinning from ear to ear. After the class went into school, Jack and I headed off again for the hotel. We visited Malinga again that night but couldn't bring him for a sleepover as we were leaving the next morning.
Our bus ride home to Kilema was long and hot AND we were almost left at the rest stop. It was actually quite comical as I thought I had heard them announce that the bus was leaving and Roman said 'no, it wouldn't be leaving yet'..next thing we look over and the bus is driving away! He made a dash to get them to stop and they slowed down but kept rolling. I was yelling in English and Swahili for them to stop and when I got to the door i put my leg up on the step so he would have to stop. By that time Roman and the kids had made it to the bus and were able to climb on...it was crazy. I yelled at the driver mainly because he saw that we were running to catch him and didn't stop. I am sure we must have left someone else behind. The 'new' experiences never stop. I also haven't told you that the driver plays loud music, usually a B-band version of a Backstreet Boys or some other mainstream artist. They also have a dilapidated Tv on board and show Nigerian soap operas or violent Asian movies. I am sure i still haven't done the whole crazy experience justice...you really had to be there.

Life in Kilema

I thought I would post some pictures of life around our house. I have posted one of the kids in the stinky pig pen with the piglets...the one behind our house. One of Patrick playing with Jack and Hannah and Yeska and Jackson our neighbors (children on Dr. Massawi,one of the docs who works at the Kilema Hospital). I have also posted a picture of Jack on the hill behind our house. There is a huge hill with a catholic shrine that has the most spectacular view of the Pare Mountains and into Kenya (which is only 20 minutes from here).
We are in Dar es salaam right now after an 8 hour hot bus ride (we are on budget travel!). We will visit Malinga again this afternoon and see if he will come to the hotel for a 'sleep-over'. It will still be another few weeks before he can live with us. It has been hard in that respect but that is how the system works. Please include us in your positive thoughts and prayers that the system works in our favour in terms of timing.
I have also posted a picutre of the 'meat shop' in Marangu. We passed it on the way home from a caravan stop last week. This, my friends, is the reason I have sworn off meat...that and the threat of Rift Valley Fever that has infected animals in Kenya. Jack has also learned how to kill and pluck the chickens that the 'chef' was preparing for the caravaners. Eric was our cook and he gave jack a real-life lesson about where the food we eat comes from. The fun never stops....you have to keep your sense of humour intact!

Caravan #2

Our caravan stops this week have been great. We had some visiting students (Brits, Germans and a lovely young medical student from St. John’s Newfoundland named Melissa Angel) join us from the Kilimanjaro Christian Medical Centre (KCMC) a fairly large hospital in Moshi. They seemed to enjoy the day that they spent with our group. I have to say that after you spend a few days with complete strangers who all have a very like-minded purpose, you can become quite efficient. By day two we were easily seeing 500 people with 3 docs and 3 nurses working together.
Moshi is a modest size town with a sprawling population of about 600,000. It is the nearest city centre from where we live and the KCMC is the hospital where Kilema hospital refers to for more complicated medical problems. I went there after the first caravan with a friend who asked me to give a ‘second’ opinion regarding a friend of hers who was ill. It is a large yet primitive looking set of buildings. The medicine ward was crowded and there were beds throughout the hallways and even in the landing at the top of the stairs. The hospital can provide most general surgeries but has a limited ICU. There is a large HIV research component that is carried out in collaboration with Duke University. It has pediatrics and maternal fetal medicine. Anything beyond that must go to Dar es Salaam. All non-invasive modern procedures (cardiac caths, laparoscopy etc) must be done through referral to India or South Africa. Occasionally patients seek care in Nairobi, 8 hours drive away. All of this next level of care is expensive and not paid for by the government…hence most of the citizens of Tanzania cannot afford it or go bankrupt trying.
Our stops this week were all so different from the first caravan as they were all located close to more populated areas. We had two busy days at dispensaries near the village of Marangu (where the most popular entrance to Kilimanjaro National Park is located). We had two full days in Himo Town, the hub I mentioned previously for trucks and travelers (and a lot more HIV/AIDS patients) and, we had two days at Kilema Hospital itself. At Kilema we ran our clinic outside under an open air area where the doctors often hold their morning ‘report’ and teaching sessions…quite a nice airy place to be compared to the two days in the ‘sweat lodge’ in Himo. The Himo clinics were held in a stone shed with a metal corrugated roof. The shed was used by the Catholic diocese to hold community meetings and other church related activities.
The cases this week were varied and interesting. There was always a sense of cross-referral and sharing of info as we worked side by side. I was most comfortable with sick old people and basic tropical medicine stuff but I would often ask Dr. Don Kilby about some of the baby related cases or difficult/unusual looking rashes. There is a ton of other sexually transmitted disease beyond HIV. Most women of child bearing age have some type of PID (pelvic inflammatory disease). We also try to treat their partners whether they are present at the clinic or not. It is hard to know if that strategy works at all or if they get re-infected within the next few weeks. I saw only a small amount of real bread and butter ‘medicine’ related cases that I was accustomed to, such as heart failure or angina. I certainly was not thinking a lot about nephrology. There is some obesity closer to the larger cities but most of these patients were grossly underweight and extremely fit from long days of hard work on their shambas. I don’t like to admit it, but, I did enjoy the variety. There were of course lots of ‘pain in the body’ consults that were mostly middle to older age women whose bodies had just had enough. Dr. Kilby was quite innovative on this caravan as he recruited a lovely and hysterically funny man named Patrick who was our resident chiropractor. Although patients got only about 5 minutes with him, I could see him working miracles on some painful shoulders and lumbar spines. He taught patients some exercises and provided a lot of comic relief. The patients really loved it and I think they thought he was doing some type of witch craft…this was like nothing they had ever seen or had done to them (see picture). Patrick always had an audience of women and men sitting on the bench watching him crack and manipulate the bones of some withered looking bodies. Many of the patients laughed out of nervousness, I think, but a lot of smiling went on in his ‘corner’. Most people here (mostly Chagga tribe) have a limited knowledge of the human body and there are some really interesting beliefs about how the body works etc. I had some little old ladies tell my translator that they started with pain in their right foot and then it travels to their right hip and shoulder and ultimately their right ear or eye…and then maybe over to the left!
I spent a fair bit of time reassuring healthy older people that they were not really sick, just old and tired from working too hard.
I have attached a picture of a child who we sent for testing who was supposed to be 12. The other pictures are of Patrick at work and one of me holding possibly the cutest baby I have seen yet (other than my own of course!). I also put one of Roman at work with Tom Kaul. I wish I could be more descriptive but the number of patients we see each day makes it a little overwhelming to try to describe the really interesting stuff.

Arusha National Park

Last weekend we visited Arusha National Park. It is the closest National Park to where we are currently living. It is uncrowded and unspoiled with tremendous natural beauty. It surrounds the base of Mount Meru and is known for its families of Giraffe that roam freely. There are no large game such as lions and rhino but there are elephants who inhabit the lower slopes of Meru. We had hoped to catch a glimpse of the elephants on our morning hike but they are quite far into the jungle at present due to the abundant rains. There is no need for them to venture out to find water holes out in the open. There are plenty of Africa Cape water buffalo and Zebra as well as hyena, large families of wart hogs (with babies) and plenty of wonderful birds. We also came across some families of blue monkey and babooons as we passed through the forested areas. They put on quite a show. We shared a magical night with our travel companions, our fellow caravaners: Tom Kaul (Kingston ER resident), Carene Davey (HIV drug rep from Toronto), Patrick Faloon (Chiropractor from Ottawa), Carolyn Showler (HIV nurse from Victoria BC). We sayed at Momella Lodge known historically for the filming of John Wayne's 'Hatari'. The lodge was built in the 1940's and consists of quaint cottages that sit at the base of Mount Meru. We sat out on our porch after dinner and watched the water buffalo graze on the lawn right in front. The sound of their chomping was quite incredible. It was a full moon that night and the moon lit up Mount Kilimanjaro like a parking lot. We could even see the flashing light of hikers summiting and camping near its peak. It was lit up until the wee hours of the morning. Quite a magical night and a great way to relax after a crazy week. I have to say that this group of people were quite an amazing bunch of human beings. I think the bonding process was helped by the fact that all 9 of us were living in our little house for the 2 weeks during the 2nd caravan but I really must say that they were each incredible people who had a lot to offer. They were especially good to my kids...who I think are now missing them terribly. The next morning the giraffes were grazing just outside the lodge fence line. Mount Meru looked beautiful in the morning mist (see picture of the kids and I).
While hiking on Mount Meru we got really close to the giraffes but, I think Jack found the game warden's rifle more interesting. Kili was clear that morning and the view was spectacular. It really looks huge when you are not living at the base of it as we are in Kilema. I can't believe Roman has convinced me to try to climb it with him at the end of our stay....he says that if I can get him to move to Africa for 4 months then the least I can do is climb the mountain with him...fair trade? I'm not so sure!

Orphans

Well, I apologize for taking so long to update. It has been a busy 10 days and I have so much to tell. I have decided to make the subject of this post, the orphans in the Kilema Kilimanjaro Region...I feel like I owe it to them to tell their story. The region surrounding 'our hospital' is a high prevalence area for HIV. I think I have mentioned it before but this is primarily due to the main road that travels through the town below the hospital named Himo Town. This is the trucking route from Nairobi in Kenya to Dar es Salaam, Tanzania's largest city. The truckers often stop for food or lodging and of course this raises the likelihood of HIV spread as they take part in other activities during their 'breaks'. The sex trade is alive and well in this region. Those men can either pass on the virus or catch it themselves. The availability of prostitutes in the area alsomakes it easier for men from the region to enjoy a night out. These men then go home and infect their partners. The effects of all of this activity over time have been devestating. We are now (and have been for a few years) seeing the emergence of children with no surviving parents. They live with grand parents or neighbors or older siblings. Most live in tiny huts in the villages surrounding Kilema. The Sisters (of our lady of Kilimanjaro, who run the hospital) started an orphan program 2 years ago that has, out of necessity, grown in leaps and bounds. Most of these children have been affected by HIV insome way and all are devastatingly poor. The program initially started with one day a month when the poor children in the region are invited to come to the Kilema Hospital Grounds. They usually receive a small snack and, if there is money available, they will be given some cooking oil or maize to take home. Some still live with parents and others not. Over the last size months, CACHA has worked to identify the highest risk orphans in that particular program. They have visited the homes of about 80 childen and documented where they live, the shelter, the care giver and health status of each child. These children now come on a separate identified day of the month. They receive a larger food package and this week were each given a pair of shoes (some new and others used). The shoes were purchased through a donation provided through Rotary in Canada. We also weighed and measured each child and had plans to complete HIV testing on somehad not yet been tested (many have and are HIV positive) but there wasn't enough test kits available in the Kilema HIV clinic to deal with the orphans who needed to be tested. We had overwhelmed the HIV clnic withpeople arriving for testing over the last two to three weeks. Each time we saw a patient at one of the dispensaries who was displaying any of the signs or symptms of AIDS , we referred them to Kilema for testing. With 3 docs and 4 nurses each seeing about 500 people per day, this resulted in a lot of referrals for counselling and testing. A number f the orphans have already been identified as positive and a few are on ARV's(anti-retrovirals). Many are not as they need to be fully assessed and reqire improvement in their nutritional status before we can safely treat them.
After 3 days of caravan the first week, there was the big monthly orphan day (yes, with the 500 kids. I missed it as I was out with the caravan in Himo Town (subject of my next post). Roman and Jack stayed behind with the CIDA and CACHA Interns to get the day off and running. In Roman's words, "it was one of the most incredible things I have ever experienced". Apparently the crowd gathered quite early and the children were exceedingly orderly. He said there was minimal pushing or shoving..for the number of kids that were present. Roman and Jack and Hannah made an attempt at playing soccer. Roman said he felt like the pied piper as he marched with 300 plus children behindhim up to the field. The others stayed behind to participate in another activity. Hannah sat with some of the little girls at the side of the field and entertained as usual..mostly saying things that she thought were funny and laughing at herself...her giggles are usually what make the kids laugh not the joke. Her Swahili is not well enough developed to really have a conversation with any of the kids. She seems to manage anyway. After the game the children all went back to the hospital area and had tea. Roman helped pour the tea and Hannah handed out something else. And Jack....played his violin (see picture to believe it!). It must have been pretty incredible to have an 8 year old Canadian boy serenading a bunch of African children. Roman said they seemed fascinated. He of course forgot to run back home and get the video camera. The Sisters thought it was a hit too.

We had a second week of busy caravan which Roman was able to fully participate in as our 'nanny' had arrived on Sunday after finishing her secondary school exams. Her name is Sylvia or as Tanzanians would pronouce 'Silivia'. She is a nice young woman who is fitting in well. It has taken a while to introduce the concept that it is ok to just play with the kids (colour or read). She wants to spend the day (or thinks she should) washing our clothes and the floors etc. Kids here are not really 'played with'or entertained in that way. They work.

After a great week of caravan (and pretty much feeling good about what we had accomplished, however small it was), we were introduced to the 'high risk' orphan group. My eyes are clouding over as I write this because yesterday was possibly the hardest day of my life. The children arrived mid-morning and we sat the eighty or so kids in the shade near the HIV clinic. As I mentioned, the initial plan was to test those who had not yet been tested but, were were soon informed that the clinic was running out of tests and it would have to be done next month. These children were visibly different than most of the sick children I had encountered even during the medical caravan. Their faces really reflected what I guess I could describe as nothing other than hopelessness. I was surprised at how difficult I found the day. There is nothing like a sick and hopeless child to make you feel completely inept. The hardest part was that we all knew that there was not much more that we could do for them that day or in the coming weeks or months. I was secretly dreaming about building a huge orphanage where everyone would be looked after, but what about the kids on the other side of mountain, can we build one there too? Sorry if I sound so weepy and pathetic but that is really how I felt....and it wasn't me who was suffering. Most of these kids need so much more than a pair of shoes. But CACHA is doing as much as they can right now with the available resources.
I will post a few pictures of Jack and Hannah putting maize flour into bags and playing hopscotch but it won't help you feel how had sad the air felt that day.

Despite my pity for myself, there were a few kids who really did smile, or shall I say beamed when we handed them their new shoes. For that moment, we had brought a little bit of hope even if it was with a second hand shoe from WalMart.