The neighborhood

This trip wouldn't have been this great without the people we met here at KCMC.  I introduced Baba Alfred and his family in a previous post.  There have also been many great residents and medical students who welcomed us to KCMC and helped us find our way around.

We've also been lucky enough to meet other medical & nursing students from all over the world, as well as a few American residents and med students we wouldn't otherwise have met.

Our house on the doctor's compound happens to be inhabited only by Americans since we've been here.  Chris, a 4th year student from Mizzou, was the only one home when we arrived and was super helpful in finding our way around, giving tips on places to get internet and how to use our Vodacom phones, and introducing us to some of the other students.  Marianna returned from a Kilimajaro climb a week into our stay, and just left for home last week after a 3 month stay.  With Chris now on his own Kili climb it's been a bit quiet around here lately.

Our roommates on our last pizza & beer outing before they left (above, left) and out in town on Marianna's last night (above, right).

We've also made friends from all over the world.  Our neighbors on this street were from Wales and Sweeden, and we spent quite a bit of time exploring with them.  The Welsh girls turned out to be excellent hostesses and cooks, planing a potluck for the international and Tanzanian students last week which was quite impressive.

Here's just part of the spread:

And a picture of all 6 of us girls:

The month wouldn't have been the same without these and so many more wonderful people we've met here.  I miss them already!

Coca-cola is everywhere

One of the most surprising things we've noticed in Tanzania is that Coca-Cola is, quite literally, everywhere.  Most signs for hotels, stores, small family businesses, restaurants, and even the Moshi post-office are Coca-Cola sponsored.  Coke even supplies tables and chairs for many local restaurants, bars, and the medical school cafeteria (below).

Even our attempts to try new things not available in the U.S., such as a delicious non-acoholic ginger beer called Stoney Tangewezie, take us back to the Coca-Cola company.  And the ubiquitious drinking water, of which we've purchased gallons during our trip, says this on the label.

"The water in this bottle originally fella s snow or rain on the top of Africa's highest mountain, Kilimanjaro.  The water filters through thousands of feet of volcanic rock and lava, it surfaces on the lower slopes of the mountain and is bottled at Shirimatunda located on the Kibo volcanic lava slope."

And then, if you read a little further:

"Trademark of the Coca-Cola company."

Seriously??  I traveled 9,000 miles over 24 hours and the only thing I can find to drink that's not made by Coca-Cola is beer!

Baba Alfred and transportation in Tanzania

We've been pleasantly surprised at how easy it is to get around Tanzania, I only really miss having a car on our long, often muddy, walk to work in the mornings.

Baba Alfred ("baba" is Swahili for dad), our self-appointed Tanzanian father and protector, is our favorite taxi driver.  He is always happy to cart us to and from town and if he is busy sends a trusted friend.  He greets all of the international students and residents with a heartfelt "hello my daughters" or "hello my sons."  He is a very safe driver, which is important when you are sharing the road with trucks, motorcycles, pedestrians, and bicycles.  This past week he invited us all to his home for dinner and to meet his family.  His daughters, nieces and nephews, and grandkids were so sweet and welcoming, we had a great time.  We were stuffed with authentic Tanzanian food by the time we left, as we were enouraged to help ourselves to seconds and even thirds.  It was delicious.

Baba Alfred, his family, and his ex-pat family from the U.S., U.K., and Sweeden.

The alternative to taxis is to take the Dala Dala.  Dala dalas are smallish minivans which are then gutted on the inside to allow room for narrower, closer seats.  There are seats for 13 (3 rows of 3 and one row of 4) plus a bench against the driver's seat that holds up to 4.  We've counted 21 people packed into the dala at once, including the driver and his copilot, who opens and closes the door and occasionally hangs out the window to recruit more passengers.  It's hard to capture the atmosphere inside a dala, but this is the best pic I've managed to date:

We generaly avoid dala dalas with the exception of the one that goes directly from KCMC to the market in Moshi, as it's a fairly low traffic road and the drivers seem pretty safe.  And the ride costs only 400 shillings, or about 25 cents.  It's an interesting system, all of the dalas are privately owned but the do have licenses and about 5 registration-type stickers on the windows.  They run pre-set routes, and the ends of the route are usually, but not always, listed somewhere among the many decorations.  It also seems to be tradition to put a slogan on the back window, usually something about Jesus or Allah.  But occasionally we find a more original one, such as "Husband is not an ATM machine" or my personal favorite, "It's easy to be me, but it's not easy to love me."  It's an interesting system and I'm glad we gave it a try a couple of times, but I must say I'm much more comfortable with Baba Alfred!

Helping Babies Breathe

Our side project while at KCMC was to do some teaching on neonatal resuscitation.  We both had just come from a month on the NICU and NRP re-certification so we felt more comfortable with this.  But we used a different curriculum designed for low-resource settings, called Helping Babies Breathe.  The program emphasizes the importance of establishing breathing in the first "golden" minute of life, and teaches important skills for assessing & assisting babies in distress.

We see a lot of children with cerebral palsy from birth asphyxia here, so there is clearly a need.  The Helping Babies breathe program has been taught at KCMC in the past, and studies have even been published in Tanzania showing the decrease in neonatal mortality as a result.  But the reality is that there aren't always enough masks available, or people who feel comfortable using them.  After many visits to the obstetrics department we were able to arrange a 1 hour teaching session with the nurses and nursing students.  A longer course would have been ideal, but we did manage to hit on the important points.  Everyone got to practice on our simulation baby, Neo Natalie, and we were able to teach good technique for bag-mask ventilation.  They seemed most excited to get the extra bag-masks we'd brought along, which I hope will get a lot of use here at KCMC.

Week 3 at KCMC

We just finished our third week at KCMC.  Like most weeks here, it had its ups and downs.  And unfortunately didn't end on the happiest note.  We're glad to have a couple more days left before we leave next week.

This week the medical students were back from their vacation, which meant a much bigger crowd on rounds, but also a few more on-the-fly teaching opportunities.  The patients continue to be very sick, and we are somewhat limited in the treatments we can offer them.  I was happy to see my favorite heart failure patient discharged at the end of the week, even though we have no cure for her she was so excited to be going back home after 3 long weeks in the hospital.  We also have quite a few cute babies admitted for antibiotics for one infection or another, and all of them are doing pretty well.

Friday was a tough day on the wards.  We have several sick patients who need things like g-tubes (semi-permanent feeding tubes inserted directly into the stomach) to prevent the recurrent aspiration pneumonias they will get due to their inability to swallow food safely.  And that just isn't available here. 

We also saw our first code on Friday, although several patients have died in the last 3 weeks this was the first one we were on hand for.  Tricia was called over by a grandmother who noticed the patient slumped over, not responsive and not breathing.  She started giving breaths with the bag-mask and called for help for almost 5 minutes before someone came to get our team from rounds.  We did about 10 minutes of CPR, with lots of chaos and less than ideal equipment, and after 1 round of epinephrine we did get a heart rate back.  Eventually she started breathing on her own too, but was not responding to pain and there is a good chance the injury to her brain from so many minutes without oxygen is just too severe.  It made us acutely aware of how great the nurses, respiratory therapists, and other members of the Children's code team really are.

We also had another baby with respiratory distress and likely congenital heart disease who wasn't looking so good this afternoon, but thankfully by the time we left she was looking better.  Her mother fainted onto Tricia while we were at bedside, probably a vasovagal episode related to the stress of having such a sick baby and not eating anything all day.

After a sad and eventful day, we had a laid back dinner at the Impala Hotel and called it a night early.

Laundry, Tanzanian style

Another quick post about daily life here in Tanzania.  Any mention of our domestic life would not be complete without mention of Mary, our "house mom" or housekeeper.  She is wonderful.  Tricia has on more than one occasion proclaimed Mary to be her favorite Tanzanian.  Mary helps with dishes and keeping the kitchen clean, and shares with Tricia the never-ending task of keeping the kitchen's ant population at bay.  She also brings new bedding - this week we got princess and Spiderman sheets!  And for an extra fee (which we gladly pay, she helps with our laundry).

Laundry in Tanzania is made more difficult by a number of factors.  We haven't seen, nor have we heard rumors of, a washing machine or dryer since we arrived in the country.  Although I don't doubt that they exist, most Tanzanians do their laundry by hand.  We've learned to hand wash things in the sink, mostly things we don't want displayed in the yard or things that can't be ironed.  Anything hung outside to dry must be ironed before wearing as mango flies love to lay their eggs in any fabric left outdoors.  And since the ambient temperature is usually somewhere between 80 and 90 degrees Farenheit and the occupants of our house have been known to climb Kilimanjaro, swim in crater lakes, and generally sweat their way around the countryside, there is almost always laundry drying in the yard and on any available makeshift clothesline in the house. Things that have been repurposed for clotheslines include the detatchable shoulder straps from our duffle bags and the multiple pane windows (below) and the phone line to a non-functioning, rotary-style land line in our house.

Laundry hanging outside (below).  Mary, likely from years of practice, is much better at laundry than we are.  She manages to do it much more quickly, and with less splashing all over the kitchen and a much fresher-smelling result.  Have I mentioned yet how much we love Mary?

The key to Tanzania

The picture above is the note left by the international program coordinator with our askari (security guard) here in the doctor's compound.   The keys open our kitchen door and bedroom door.

At the first hotel we had a similar, if not identical, key which we found charming and quaint.  But as we've traveled the country we've had matching keys in multiple safari lodges, the huts on Kilimanjaro, and the tented camp at lake Chala.  Which makes us wonder how many unique keys and locks really exist in Tanzania, and how secure the locks really are.  Thank goodness for the askari!

Thankfully, at least at the doctor's compound they forgo the carved wooden or occasionally stamped leather keychains which, although very ornate, are usually the size of my shoe and equally convenient to lug around.