Saturday, February 9, 2013

Dar es Salaam and Amsterdam


The eight of us are now in the DAR airport, Julius Nyerere International.  It is nearly 10 PM and boarding should start in about an hour for 11:59 PM departure.

Yesterday was a productive day.  The Pharms went to Muhimbili University’s School of Pharmacy.  They met with the outgoing and incoming deans for a mutually beneficial meeting.  I don’t know the language, but they did talk about capsule manufacture and pill making.  Or something.

Now Tessa and I really had fun!  We went to Power Foods where Plumpy’Nut is manufactured.  It is a small factory with stainless steel machines in a couple rooms where we could peer in, but not enter.  The workers wear special clothes, etc.  Most of the space is actually warehouse for the twenty tons of Plumpy’Nut they manufacture each week.  Twenty tons! 

They do make a couple other products, mostly special flours, but the real deal is the Plumpy’Nut.

Kulwa, our driver, patiently waited.  After our exhilarating tour, we picked up the rest of the group.  We still had a couple hours before dinner so we asked Kulwa to take us to the beach for a while.  He took us to Coco Beach, well known as a classy place.  It was.  We sat ocean-side and sipped a cool one.  It’s only an expression.  Kiswahili is “baridi.”  They warmed up pretty quickly in the heat.  We still had a great time.  Some walked the beach for a time then we sat in the cool shade.

Dinner was with Dr. Saga and his three sons, Grey, Fadhili and Godfrey.  Grey works for USAID, so we had a great talk.

This morning, we went to Slipway and caught the ferry to Bongoyo Island.  It has beautiful beaches and some nice little bandas, loungers and chairs.  We had lunch there too.  It was tasty, but we did need to hurry to catch our boat back to the mainland.  A couple of people who should know better got pretty burned today.  Despite the fact they did use sunscreen, the Tanzanian sun bested them.  I cannot tell you their names, but their initials are Ken and Laura.  Amazingly, the others did fairly well.

We went to Sea Cliff Hotel and ate at the restaurant Karambezi Café.  It has become more or less a tradition to do that.  It is so nice to sit in the open and look out at the ocean.  The food was good.  Several desserts were had and enjoyed.

And now we are waiting to board KLM flight 567.

Amsterdam

Arrived in Amsterdam and ready to board the flight home.  Slept a little.  Off to the gate.  Don't want to miss this one!


Wednesday, February 6, 2013

Random thoughts as we prepare to depart


First, there is so much left to say and I cannot cover it all myself.  I can only hope some of my colleagues offer their voices.  It would be a much more beautiful harmony than this solitary voice.

I was noticing things today.  Ally was looking out across the beautiful savannah and enjoying the spectacular view.  It is among my top favorite views in the world.  OK, so there are a few of them.  Let’s not split hairs.

On the low end, I noticed that burning trash smells the same as it does at home – unpleasant.  But also, the fragrance of freshly cut grass is the same sweet pleasure.  The fresh smell of rain is also the same as at home.  I suppose you won’t be able to remember that for a few months as you go outside and your nose burns from the cold!  But I give you my word, it smells the same here in Africa as at home.

The people are kind too.  They are especially tolerant of wazungu attempts at their language.  They seem surprised and pleased, even if they often laugh too.  I think I can speak for all when I say we were gratified at the response to our education sessions on Hypertension and Diabetes.   The pharmacy folks on drugs and more and Tessa on nutrition and more really shined!  It would NOT have happened without them.  Now Dr. Rite has in mind next year we should cover neonatal care and resuscitation (Kelsey Watt, Pediatrician comes to mind, and Jane from the Ob. side), fracture management (Jane, think that orthopedist you know is available?) and benign prostatic hypertrophy and prostate cancer (some primary care doc and an oncologist seem likely candidates, especially an old PC specialist).

At the moment, we are on the bus and just passed through Kitonga Gorge.  Only saw one apparent head-on truck collision on the roadside.  It is still a long way to Dar.

We left Ilula at 9:10 AM.  Gary returned the Lubawas’ car to Tumaini and got caught in rush hour traffic.  This was non-existent a few years ago but is obvious now.  I went to take a few photos of the unfinished Nursing School Dorm and Multi-Purpose building with Emmanuel, Ilula’s Lab Director.  He decided we should take and alternate route back up the hill to the Ilula campus.  “Wet,” he said.  As it happened this coincidentally provided him an opportunity to go right past his house for an impromptu visit to meet his wife and see the house he is renting.  I was a little anxious that I would be holding up the group, but since Gary had been nudged into operating on Africa time, no worries.  Hakuna matata!

We arrived in Dar about 6:15 our time, safe and sound.

Time for dinner!


Saturday, February 2, 2013

Mbigili Lutheran Church


Ok, this one is a week late and you may have read the punch line.  Our friend Beate from Amani Orphans Home Mbigili invited our group over to visit and play with the kids.  Jane Cassleton had brought a Whiffle Ball and Bat, so despite the inclement weather, we did manage to get in a few innings of baseball.  We started by showing them how to hit the ball.  Duh.  Like they needed lessons.  The part they didn’t get was the base running.  One would it the ball and several would run to the tree, er, uh, base. Or another tree.  Pretty soon all the kids were running the bases and the wazungu were trying to hit them with the ball (whiffle ball, remember?).  Soon it started raining a bit, so the game was over.  I think we declared everyone a winner.

Sunday, I went to church at Mbigili Lutheran Church, sponsored by Richfield Lutheran Church.  Last year, when they wondered who this Olson was, they looked through the Richfield Lutheran Church Directory to find me, but without any success.  I think Pastor Rolf had been there just a couple years ago.  Nope.  We do not have the good fortune to be related.  But it is probably true that we all look alike to the Tanzanians!




We missed the pastor.  He was at Image (e-mah’-gee, not im’-ij) for a multiple ordination.  Five hours, not including 2 hours travel time each way.  The evangelist did a fine job. 

Outside the church, I noticed a little girl, six or seven, I suppose.  She had ratty hair with crusts on her scalp.  You may have read this earlier.  It is called Tinea capitis, a fungal infection of the scalp. It occurs in the US, but it is a result of poverty and dirt.


Enough is enough.

A Day at Ilula


Thursday, January 31, 2013

It was an interesting day.  We started the day by saying goodbye to Dr. Jane, Dede  Ouren and Mary Thompson.  It was great to have them all.  We had the privilege of keeping Mary and Dede an extra week due to some scheduling difficulties that worked to our advantage.  They had a great time and again it was to our advantage.  This was a synergism for us with Jane Casselton too.  She is originally form N. St. Paul, now a 4th year medical student at Tulane, planning on obstetrics and gynecology.  She worked hard, did well and was an integral part of the team.  She got lots of C-section and delivery experience, we got a great resource.

We went on rounds after morning report.  We saw two septic neonates, one three days, the other two weeks old.  We pondered the proper treatments.  One needed an IV that was difficult.  She needed to be off oxygen for an hour.  I hope she is improved by morning.  The other was doing a little better. 

Next, we saw a young man injured playing “football” yesterday evening.  He was having increasing belly pain and looked awful.  He had an acute abdomen.  Among several possibilities would be a ruptured spleen.  He was transferred to Iringa.  Likely he got an exploratory surgery in lieu of the CT scan he would get in the US.

We also saw a kid who looked quite scared.  He had a swollen foot, but Dr. Saga said he was out of the woods by about 4 hours after his snakebite and this was the next morning.  I would still look scared, I am sure!  He was discharged.  It wasn’t a black mamba.  Or a spitting cobra.

This afternoon, we put on a three-hour conference on hypertension.  Tomorrow it is diabetes.  It went well today.  The Doctor-in-Charge said it was well received by the attendees.  Actually, he said they thought it was “Great!”  We were pleased.  Of course Dr. Rite said he thinks we should do some conference for them every year!

At this moment some of the women are locked out of their residence.  Somehow the old-style key broke off in the lock.  Ah!  Success!  Dr. Moody and my Leatherman got the door open.  Whew!

Sadly, we learned that the boy we sent to Iringa died in surgery.  So did one of the babies.  Sometimes we are helpless even when we know what to do.

Just a normal day at Ilula Lutheran District Hospital.  Then there is tomorrow.

Irindi

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Tuesday, January 29, 2013

The Institute of Agriculture vehicle and Roger Blomquist picked up Tessa and me at 9:15 AM.  We walked to meet them, since the main road in Iringa is torn up to put in a storm sewer.  There is a big trench, scheduled to be back-filled by tomorrow.  Didn’t go to see if it had been done.  (It wasn't until Saturday.

We drove to Irindi.  It is this side of Ruaha Mbyuni.  (Say “Ruaha Mbyuni” three times if you can.)  Irindi itself is a way off the asphalt.  Pastor Felix met us.  We drove another 6 km to the demonstration plot.  They are growing rice, not corn, since their plot is quite wet.  It has been a little dry until now, so the planting is about two weeks late.  With some rain the crop can catch up.

We had the opportunity to ask some nutrition questions after Venance gave his instruction about the rice crop management.  We learned a great deal.  One important item is that they would like nutrition information.

 The photo below is a field of tightly packed rice seedlings.  To the right is a field of newly planted seedlings in rows.  It is the first time the Institute of Agriculture has done a demonstration with rice.  About one third of the plant should be under water and the plot is about two weeks behind.  This was Thursday and it has rained the last three nights, so tthey should be fine now.  We hope.


On the way back to Ilula, my friend Beate from Amani orphanage asked if I could look at a couple kids.  On Sunday we saw a little girl with a fungus infection of the scalp that is generally the product of poverty and dirty living conditions.  Now apparently a boy at school had been identified with a rash on the scalp too.  I went to see him.  I think it is just impetigo, but we will know in a few days if it doesn’t quickly respond.  They have a couple other kids at Amani with impetigo too.  I don’t think it is an epidemic, but a couple kids are pretty uncomfortable.  Also, since there are a number of kids with HIV, fungal infections are quite common.

Luisa, Beate, myself and one of the Amani staff as translator went to deliver the antifungal to the little girl from church.  Her mama was holding a newborn and I recognized the woman from the hospital last week.  Of course, the little girl from church was not the only child with Tinea capitis.  We gave another girl the remaining pills we had.  At least they know what is needed and how to use them after we leave next week.

Friday, February 1, 2013

Happy Birthday, Ken!

Ken na Rafiki
Today we celebrate Ken's birthday, who has been an amazing mentor, resource, and friend this trip. Thank you, Ken, for your dedication to this hospital, these people, and to the incredible learning experience for all students here.

Wednesday, January 30, 2013

PIzza Wednesday

It's finally Pizza Wednesday! We have been planning this evening for many days, giddy in anticipation for the gooey goodness of greasy comfort food. However, it marks a bittersweet night: the night before our beloved daktari Jane and Nurse DeDe and Mary will be leaving. This mini party will be a small going away party for these wonderful people. Jane and I had a fun rain run this afternoon, since last night's downpour encouraged a lazy morning this morning. We returned to a wonderful post-run feast of rice and peas, cabbage, pineapple, mango, and of course, Jane's Tony Chach seasoning.
We have spent most of our day preparing for our training sessions about Diabetes and Hypertension that we will present to the medical staff here at Ilula tomorrow and Friday. Yesterday was another incredibly stimulating and exciting day. Ken and I headed to a small village with the director of the Institute of Agriculture at Tumaini University, who sponsors the COmpanion Village Project, aimed at increasing the crop yield of villages through collaboration with the village pastor. We were able to fit in a small nutrition lesson, as well as a water purifying technique using the heat and UV rays from the sun. The villagers were very responsive and it was a very rewarding experience.
We distributed more Plumpy'nut today to malnourished children, whose parents were very appreciative. It is always a wonderful feeling to pass out this nutritional supplement, but you always wish you could do more for the family.
The Minneapolis weather is not at all inviting. How I wish I could stay in this sunny 85 degree weather forever. We only have one week left here in Ilula before 2 days in Dar, where we will fly out of. I am already dreading the transition back to reality, where chickens do not run wild and clothes are not hung to dry in the sun. The good news is, I have a feeling this is not my last time here.

Tuesday, January 29, 2013

Monday Good news- Bad news

Monday, 28/01/2013
Since Friday was a national holiday (Mohammed's birthday) and Sat & Sun the OPD clinics were closed Monday brought out the crowds.  There was standing room only in the OPD hallway and long lines at registration, the lab, and the Pharmacy.  
The 3 Dunguya friends referred by the Palliative care team on Thursday arrived via motorcycle in spite of the muddy road conditions.  Sunday brought a torrential downpour to the area.  And today we had more rain later in the afternoon.  Electrical power was intermittent for two days following.
Good news - bad news!  The first patient had a negative cervical cancer smear but the 2nd patient was HIV positive on re-testing.  
The first patient received antibiotics at no cost for a vaginal infection  ( paid for partially by the hospital "poor patient fund", CTC, and another donation by a MN visiting nurse ;).  Although the antibiotics were covered it took two trips to the community pharmacy to locate and purchase the correct amount as the hospital pharmacy was out of stock.  Although the order clearly stated  2 gm every day for 5 days, the clerk would only sell me 5 Gm the first trip.  So I walked back to the hospital pharmacy to re-confirm the dosage and learn a few more Kiswahili words to make my case that I needed 5 more vials.  Hurrah!  I was successful on my 2nd trip.  The general ward nurse inserted an IV catheter with an insertion port and gave the first dose.  Now let's pray the patient will return the next four days to complete the course.  She has no family in Ilula so will have to make the trip back and forth every day to that remote village by foot.  It will take her 2-3 hours each way.  

The other two patients were counseled and treated in CTC.   Healthcare in Ilula.  
All's well that ends well but in Tanzania the heart wrenching stories never end.  

Palliative rounds at Ilula

Ilula hospital palliative care rounds leave one astounded at the caring and commitment of the team.  Two nurses, a clinical officer (comparable to a physician's assistant in USA), and a chaplain travel to surrounding villages to visit patient's with terminal or chronic diseases.  They assess current and ongoing medical, psychological, social, and daily living needs.  These patients are cared for by family members- grandparents, grandchildren, children, spouses, siblings, cousins, etc.   Many times the patient is the sole care provider for other family members.  One I vividly remember was a grandmother with cervical cancer caring for her three orphaned grandchildren.  Another was an elderly woman with no means of support caring for her husband who was bedridden due to a serious hip injury 5 years ago.  Their eldest son had died of malaria when he was in college.  The younger two sons were unemployed and reportedly no help to the parents due to excess drinking. There was no food in the home when we visited.  We left our donuts and energy bars brought along for lunch.  
Another 35 yr old woman living with HIV was experiencing a two day illness with fever, headache, neck pain, coughing, and general malaise.  It was recommended that she go to the out patient clinic at the hospital to be tested for malaria but had no money for the registration fee of 2000 Tsh equal to $1.25 USD.  The chaplain gave her the money. 

On another day at a remote village one of the women living with HIV was experiencing some clinical signs and symptoms of an infection and was advised to be checked at the CTC (Clinton Foundation Counseling and Treatment Center for AIDS and HIV) on the Ilula Hospital campus.  Her only means of transportation were  walking (3 hours one way), riding a bicycle (she does not know how to ride a bike), hitch hiking (unreliable as cars rarely make it to this village due to washed out roads, or hiring a motorcycle which would cost 10,000 Tsh ($6.25).  That was a no brainer!  I could easily donate $6.25 for a motorcycle ride for this community volunteer who was recruiting villagers to be tested for HIV.    In the afternoon this admirable team split up so half could continue visiting patients in homes and the others set up a mobile HIV testing clinic.  20 patients ages 8-70 (12 F; 8 M) were counseled and tested for HIV. One was  indeterminate; one was reactive.  Both were referred to CTC; one for re-testing and the other for ARV treatment.  
Back in the hospital van we prayed the driver would be able to keep the vehicle upright as we curved around potholes, boulders, up and down into washed out sections , and over rutted trails.  Luckily there were only six of us in the back so we could have two buns each on the benches for balance.  On the way up to Dunguya we gave 7 young schoolchildren a ride home for lunch and on the way back we gave a woman a ride to a neighboring village.  They think nothing of squeezing 10-12 in the back and 3 in the front on these outreach trips.
Warm greetings from Tanzania.  Dede

Friday, January 25, 2013

Plumpy’Nut


 A Pastor friend, Bonnie Wilcox, a veteran of Tanzania trips, asked how Plumpy’Nut came to be at Ilula Hospital.  This is a story that bears endless repetition (if you ask me!), so I am happy to oblige.  She mentions an organization called Edesia that uses Plumpy’Nut around the world.

In 2011, one of our first med students, Kelsey Watt, MD, now a Pediatric Resident in Colorado, and I were the last to go home from Ilula.  While we were here, we were stuck by several very ill children.  I have photos of two of them, but truly, they are gruesome and for the eyes of medical personnel only.  You will need to use your own imagination, but I think you can hardly overdo it.  One of the children died 2 hours after admission.  She was two and looked like a bag of bones.  This is marasmus.  The other, about 18 months, was swollen all over, with puffy cheeks, puffy hands and feet and tremendously swollen genitalia.  This is kwashiorkor.  This boy was here for our entire stay.  I do not think we did anything for him that helped.  Both would have been fine with a six-week course of Plumpy’Nut.

Someone told us of this product.  Kelsey and I looked into it.  We even developed a talk centered around malnutrition.  Well, Kelsey did most of the work, I edited it, but I get credit due to being the “professor.”  Call or write me if you want to hear it!

I brought the story home to my congregation at St. James, who graciously had a special offering for us to share with our local food shelf.  In a conversation with my lovely mom, I told her the Plumpy’Nut story.  Her circle at Zion Lutheran in Anoka graciously made another contribution.

We were able to buy about ten cartons of Plumpy’Nut, 13.8 kg, each with about 150 sachets of the stuff.  For children between 6 months and 3 years, our target population, 1-2 sachets (packets) per day is the dose.  The full course is six weeks.  But only 2% of children die of malnutrition directly.  But it figures prominently I 80% of deaths in children under five.  Malnutrition kills by potentiating any other illness.

Of course, there are varying degrees of under nutrition, both acute and chronic.  The average need for Plumpy’Nut is about 2 weeks and one packet per day.

For Tanzania, the national statistic is that 38% of children under five are stunted (low height for age).  This is a sign of chronic malnutrition.  Thirty-eight percent! 

All children admitted to the hospital are nutritionally stressed.  And furthermore, since the families provide food for their loved ones who are patients, anyone undernourished when they are admitted are likely to remain so.

We developed a protocol for prescription of the Plump’Nut and a concept paper for a program, too long to present here, but a description of it might be good for another post.  Many children relapse in 3 – 4 months.  So treatment at the hospital is the easy part!

My dear church and others have provided enough Plumpy’Nut for about 1/3 of the need for the worst cases, but I would like to expand its use if possible.  For example, some of you have met Amri Lubawa, a young lawyer who is paralyzed and with terrible bedsores.  We think he looks wasted compared to last summer.  I was hoping to get a grant to supply it ongoing for Ilula Lutheran District Hospital, but so far no luck.  “I have not yet begun to fight!” to quote John Paul Jones.  (And I would gladly accept help and advice.) 

What the heck is this magical formulation anyway?  It is (by weight) approximately one part peanut butter, one part powdered milk, one part powdered sugar, one-half part oil, like sunflower oil and necessary micronutrients (vitamins, etc.).  Plumpy’Nut is a brand name.  The WHO has a recipe and I would love to see a version made here locally!

Anyone want to help or donate or point me toward the funding?

Thursday, January 24, 2013

Human Interest Stories – an everyday occurrence at ILH

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Laura Brown is one of our Pharmacy Residents.  She was here last year as a student and came back!  Yesterday she became an “everyday hero.”

There was a 14 month-old child admitted with malaria and pretty typical symptoms of fever, lethargy and anemia.  The malaria can tear up the red blood cells.  This infant’s hemoglobin was 2.8.  Normal would be more like 15.8.  There are people wandering around with hemoglobin nearly this low.  Mostly they have pernicious anemia.  But they got there slowly.  When hemoglobin drops to this level quickly however, it is a disaster.  The body cannot transport enough oxygen to feed the tissues, let alone heal.  This little tike needed a transfusion.
After transfusion!

As Laura modestly put it, “There were lots of us willing to give a blood donation.  But everyone else had their immunizations before they came.  Mine were up to date from a year ago.”  So she donated a pint of blood.  Our little friend made a miraculous recover and today was standing by mama.  She isn’t done with her treatment, but she is recovering, thanks to Laura’s gift of life.  These stories are not just about the wazungu.  Many of the employees give blood when it is needed.  They are everyday heroes too.  It is a daily occurrence here.

Today Augustana Lutheran Church visited Ilula Lutheran Hospital, so I had the privilege of giving them the tour.  Then they feasted with us at lunch on Anna’s great cooking.  We went by the Private Ward, where Amri is.  You may recall the name if you read Iringa-Friends-2012.  He is still here and has been now for nearly a year.  He is still dealing with pressure sores.  The Augustana people were gracious and generous to give money toward his care and to the Poor Patients’ Fund.

They had a novel idea also: What would a donation of $10, $20, $50 or more supply?

I can put a face on some of that.  A full course of Plumpy’Nut (RUTF, “ready to use therapeutic food), a sachet (packet) per day for six weeks would be around $16.  (Not much, unless your entire annual income is $360.)  More typically, we would use for a couple weeks, so $5.  We will have about a thousand kids under five years of age admitted to ILH.  Of those, 38% are stunted, a sign of long-term under nutrition.  But ALL of the children are under nutritional stress.  Just counting the 380 kids who need RUTF for 10 days or so, now we have 3800 doses needed per year, just for the children overtly under nourished and not including any of the children who need nutritional support during their illnesses. 

I am proud and thankful to say that again tis year, St. James came through with enough donations for fully 1/3 of what the hospital needs.  Way to go, St. James!

Wednesday, January 23, 2013

Ruaha National Park

Meet Taja.  She was such a model for us and is just a glimpse of the amazing animals we saw on our Safari.  I'm sure more pictures will follow, but I know some people back home would love a sneak preview.  The weekend in Ruaha was outstanding and such a treat amidst a lot of hard work by the entire team here.  It was such a great way to send off the crew that is now on their way to Dar to fly back to Minnesota and to welcome Vandi to the team.

Huruma Centre, January 22, 2013


Dear Friends,
Here is a non-medical miracle from our friend Gary Langness, one of the influential in BKB.  He wrote and sent the following to his friends and family and he gave me permission to reprint it here.  The point of this isn’t that I had the privilege to participate.  It is that Mama Chilewa has put in yeoman’s effort for the many orphans she has helped, with way too little help.  Too few teachers that need to be paid, buildings unoccupied because it takes increased overhead to use them.  It isn’t so hard to get money for a building (believe it or not), but it is difficult to get funds for operations, especially since they need to be ongoing, not a one time donation.
Here is the story from Gary:
We have heard that it is very cold in Minnesota so I thought I would send you an email so you had something to do other than to wonder when it would be warm again.
On Monday Carol and I went to the Huruma Centre, the orphanage where Mama Chilewa is the director.  Our purpose was to find out the cost of providing new school uniforms, sweaters, and shoes for 36 primary school children that live at the orphanage.  Mama was also going to have a list of the school fees for each child so we could secure the needed money from the local bank and pay the fees.  As we sat down in her office I noticed that Amy, one of the care givers was hand writing a list and I wondered why it was not being done on Mama’s computer.  About that time Mama said very quietly, “I am old and so is this computer.”  She was trying to print out the school fee sheet… it was not working… it would have to be done by hand.
As we were leaving Mama looked at Carol and said, “May I ask you something?”  Receiving an affirmative response from Carol she asked about the possibility of securing a computer from the U.S.  The problem with purchasing a new computer in Tanzania is that you can never be sure that all the parts are new and that it will work once you get it home.  “How much would it cost?” she asked.  I looked at her and realized that everything about life was hard for Mama.  She was dejected and appeared to be tired of always trying to do something positive for the children but never quite having what she needed.  I told her I did not know how much a computer would cost but we would check into it.  She thanked us and we headed home.
Back at our apartment sit two HP laptop computers.  I have this friend Tom who is the Director of Development at Luther Seminary.  A few years ago, Tom spent several weeks with us here in Iringa.  He knows about the people and the needs.  The last two years Tom has purchased two reconditioned laptops for us to bring over here and use where needed.  I offered to pay, but Tom just smiles and says, “I want to do this.”  My Scandinavian background has me silently protesting thinking I should say I would be happy to pay for them… instead I say to myself, “Quiet... just accept the gift… say thank you… let Tom know and experience the joy of giving. “ I then called Dan McIntyre and asked him if he could equip the computers with software… “Yes, I be happy to do that!”
On the way home from the Huruma Centre we stopped for lunch.  Once seated, I called Ken Olson, a family doctor from St. James Lutheran Church in Bursnville.  Not only does he know medicine he also knows computers… in fact he builds them.  I asked him if he might have time to go with us to the Huruma Centre… back to see Mama Chilewa… bring her one of the laptops sitting in our apartment and hook it all up.  He did not say yes… he said, “I’d love to!”  I called Mama and asked if she was still in her office… she was… I told her we would be there in 15 minutes.  Ken, Carol, the laptop and Gary headed for Huruma.  As we walked into her office and she spotted the laptop she began to smile.  Ken sat down and did what computer geeks do… hooked it all up to the printer… made it all work.  Then he invited Mama to sit next to him as he taught her how to use it… I noticed Ken would just point to buttons she could push and Mama pushed them… the smile on her face grew larger… tears welled up in her eyes and I thought there might be a lump in her throat… and then she said, “This is a miracle.” Is it a miracle I thought… well not the feeding of 5,000 with a few loaves and bread and two fish kind of miracle… but to Mama it was a miracle and the smile on her face made me a believer.
I saw the joy in the face and eyes of Ken and I wondered if it was a miracle for him as well… well not the catching so many fish that the boat nearly sank and having to call for help from fellow fishermen kind of a miracle… but the miracle of joy in Ken’s heart as he just made life much easier for Mama and the kids at Huruma.
Then Carol offered to spend time with Mama today, transferring documents and getting the computer to do what Mama needed.  These two women, from different continents and backgrounds sat together and made good progress… and they  laughed and smiled and bonded even more deeply… and it is a miracle… well not the changing water into wine kind of miracle but a miracle of friendship and the joy that both of these women will share for the rest of their lives.
As I watched this all play out I realized this is all that I ever wanted as a parish pastor… to share the good news of Jesus and to help people become generous so they might know the joy that comes from giving… so that the lives of others might be better… and along the way to sense a joy they never felt before that leaves them smiling on the inside and on the outside.
Mama smiles today… so does Dan… so does Tom… so does Ken… so does Carol… and so do I because I had the opportunity to see the joy in all of them… it is enough to make me want to dance… but that would not be a pretty sight, so I will just smile…. that is what the miracle of generosity does to you.
One more laptop sits on our desk… I wonder who will be the recipient… I can hardly wait to find out.
And for you who might have taken the time to read this I would like to invite you into the joy of generosity… it will leave you smiling and it will bring joy to the very heart of God.
Gary & Carol

Worlds Apart

Well, I am not even sure where to start. My failure to blog is a reflection of the jam-packed, action-packed past week I have had. Has it truly only been a week? That seems impossible.
Last Thursday I went on home hospice visits to a nearby village. We crammed into the hospital's van and set out to check up on patients who are unable to come to the hospital for care. The van bounced along the dirt road, gospel blaring with the 3 nurses singing loudly along. Anne, Kari, Mary, DeDe and I hummed along and I studied the roads. A very simple thing, yes, but it symbolizes so much about my journey thus far. The roads are a rich red/orange color, constantly changing in width and texture, winding beautifully around small mud huts and excited children. These same roads offer a soft surface for my morning runs, a bumpy washboard for our road trip to Ruaha National Park, and narrow paths reaching the most rural and most vulnerable populations. As many of these experiences are, the home visits were difficult to grasp. The most amazing part of the whole visit was finding out what the purpose of the home visit actually was: spirit. We had a box full of pain meds and antibiotics, and while we assessed the patient's physical conditions, much of the visit was spent laughing and singing with the patient and their families. The visit ended with a prayer to continue to protect the sick patient, and we would be on our way to the next home. Such an incredibly powerful experience. Three of the patients greeted us with "oh, white people are here, god must still love me." This of course, was translated through the nurse, but I couldn't help but to feel uneasy by this comment.
We were out in this village for about 6-7 hours, and returned to quickly inhale food and go on to the next emotional experience: Amani Orphanage. 55 children greeted us, one being the 2 year old, Henrietta, that was a living example of the power of a nutritional supplement, Plumpy'Nut. Tears filled my eyes when I saw this child, hearing stories of her fragile body just a year ago when Ken saw her, staring back at me with plump cheeks and lively eyes. I have the children on video singing and dancing for us, which again, brought more tears. The orphanage itself was one of the most impressive places I have ever been. The kids and staff live completely off the land, with a beautiful farm behind the buildings. They have pigs, cows, chickens, they grow their own mushrooms and vegetables and fruits. The methane from the cow manure is transfered through a pipe to cook the food. I was in awe.

Friday was travel day. We woke up an hopped on the bus to get to Tungamulenga (sp?), a village about 2.5 hours away. Bega Kwa Bega, the organization through which this entire experience is possible, provided support to these villages for building wells, churches, or schools. These congragations were companion congregations to many congregations in the Twin Cities. We visited 4 villages to see the progress. These visits unbelievable. The first village, the Masai men and women performed a jumping/vibrating dance that I could have watched for hours. The Masai women are simply stunning. We were given food and drink at every church and the last church even auctioned off a chicken in our honor. Pretty awesome.

The next morning we set off to Ruaha National Park for a Safari. Every day of this trip seems to get more surreal. We were treated like royalty (I never got the hang of having my chair pulled in and out) and stayed in the most whimsical quarters. We had open air bandas with a tent that zipped during the night. The safari animals were sometimes spotted outside the quarters, and we even had a bamboo steal on of our traveler's sugar jar on the coffee tray. And the food, oh the food. We all had not seen fresh vegetables for days, so we piled our plates high. We then set out to see animals! Zebras, elephants, lions, a jaguar, giraffes, they just kept coming. To see these animals in their natural environment was just incredible. I felt like I was in a movie. I do not have the pics uploaded to my computer yet, but hopefully can post come later. We had 3 4 hour trips of this excitement, giggling all the way, trying to sight the tiny "Dik-dik" and getting roared at by protective elephant mothers.

Every time I step out the door here, there is a chance to learn. Whether it be the gestation of an elephant (22 months!!) or the symptoms of dysentery, it is never ending. I feel so incredibly lucky every moment of being here and even more lucky to still have 2 weeks to go. We lost about half our group this morning. It was so sad to see all of the amazing doctors and nurses leave, but we still have good old Ken and Gary to guide us through.

This morning during rounds, I distributed my first packet of plumpy'nut. The two year old had malaria and did not have an appetite, so hadn't eaten for the past two days. While he was not noticeably "wasted," it was almost guaranteed he was malnourished. Of all the dreams I have already accomplished being here, this experience was very powerful because I felt like I made a direct impact on this child's well-being. My innate need to nourish was fulfilled and I felt complete. However, the next patient was not as easy to treat. A 4 month old with a hemoglobin of 2.8 gm/dL (normal is around 10-14)
Her little chest was rising and falling so fast I could not stand it. With a Hb this low, they perform blood transfusions here. The only problem: there was no donated blood. I immediately offered mine, and the doctors joked I would turn her into a mzungu (white person). After further assessment, turns out I am not allowed to donate since I just received vaccinations for this trip. Laura, the pharm resident, did not receive vaccinations this trip, so was able to come to the rescue. I can rest easy. I am going to check on the babe after this.
Well, that is the tired version of my past few days (we are all exhausted!) but hopefully I will have more energy to contribute more later. What beauty there is in this life and culture. I am, as always, unable to fully articulate the admiration and appreciation I have for these people and this experience.

Monday, January 21, 2013

Iringa


Sunday, January 20, 2013

First of all, Happy Birthday Mom!  I hope you had a great time at Champp’s!  I know you are 78 or 88, but I cannot remember which.  If I am nearly 65, I suppose it isn’t 78, since I think I would have heard about it if you were 13 when I was born.  No, wait.  I must be 55.  Hmmm.  Then I was 13 when Chris was born.  But he cannot possibly be 42!  Yikes, let me out of here before I get in real trouble!  Happy Birthday anyway!

Mwa Moody (a name bestowed by the Tanzanians) and Dr. Saga picked me up at 8:30 this morning.  We managed a cup of kahawa at the Lutheran Center before we went off to Kihesa to church.  The service was to start at 9:30 am, but “TIA” (this is Africa).  So we listened to a terrific Young Womens’ choir and a kids’ choir for about 20 minutes before the robed officials came in.  Dr. Jane Casselton, MS4 at Tulane traded the title of Dr. for Mchungaji (Pastor) for the day.  She was also made an honorary member of Kihesa, having been to Tanzania and her church’s (St. Mark’s, N. St. Paul) companion congregation 6 times, first when she was 15!

The Youth Choir was truly joyful, with choreographed dance steps with their songs before church started.  They danced to the songs the Young Women’s Choir sang too.  They had the moves!  The kids of each choir could really belt it out.  What fun!  I always love to hear our kids sing at home, but I think they could really take a lesson.

The kids started out very quietly for one of their songs then really sang jubilantly, dancing with great joy.

We all got to introduce ourselves.  I can finally say, “Jina langu ni Daktari Ken,” without stammering.  Besides English, many know my only other fluent language is, uh, Pig Latin.  “I-may ame-nay is-way Octar-Day En-Kay.” 

It was a relaxing day, a walk with friends, a nice conversation on the porch of the International School and some time to do some work and thinking.

Monday, January 21, 2013

One fairly frequent but still disconcerting thing happened yesterday.  A young Tanzanian man followed me a ways, then started up a conversation.  This is the standard way this is done.  Ultimately, he asked me for a job because he wanted to go to school.  I have no jobs to offer.  I did tell him he should go to DIRA (the diocese office) to ask for help.  Naturally he said he had already been there.  We parted ways as we walked on, but this left me with a twinge of discomfort, perhaps somewhat due to my Scandinavian heritage.  He was able to ask, despite knowledge I was unable to offer.  There is no end to need here.  Some of those who receive are scammers – I don’t believe the young man was, but I do not know.  I do know that most are not.

Modern Tanzanian
Here is another example.  One of the visitors here was approached by the fiancé of someone he knows and trusts.  The young woman called and said she was very sick with malaria and needed some money.  The amount was not consistent with malaria treatment, however.  What she really needed it for, under the guise of illness, was to pay her tuition.  It is sad that we need to keep our guard up so tight. 

Here is  a photo I hope you appreciate.


Sunday, January 20, 2013

Day of Grace

Iringa, January 16, 2013

It is 10PM in Ilula Tanzania and a large portion of the world.  It is quite dark under the waxing moon, almost half.  You will see the same moon I do later tonight, since where most of my friends and loved ones are under Central Standard Time (GMT+6, I believe.)  We arrived at Ilula after Day of Grace (DoG) 2 of 3, around 8 PM.

DoG is a big deal.  Pastor Tom Hansen conceived of the notion several years ago and this is the second DoG.  Tom saw a need for the Iringa Diocese Pastors to “kick back” and have a little fun as well as have an educational session without the stress of some synodical requirement.  The pastors simply don’t get together for fun.

One essential component of this conference is a medical one.  Dr. Randy Hurley and Tom wondered if the pastors would appreciate a screening physical exam.  After a little stuttering for a couple years, last year it came to be.  The Pastors, men and women were examined, blood sugars and blood pressures were checked and recommendations made.  We learned some things.

For one, pastors’ spouses need the same things.  Of course, they enjoyed the educational and worship sessions and why not examine the spouses, mostly wives, next year?  Next year turned into this year and here we are.  Today we did about 80 histories and physical exams, including cervical cancer screening exams, with the blood pressures, blood sugars, vision screens.

Ilula, January 17, 2013

It is good to be back to Ilula!  So much of interest!  Saw a small guy with kwashiorkor, 17 months, puffy face, hands and feet, drowsy and hard to arouse.  Here is a photo too.  



We gave him the Plumpy’Nut.  First, we do a food trial.  If he will take the P’N avidly, he stays on it.  If he cannot take it – too weak, uninterested (hey, who doesn’t like a Bit-O’-Honey?), he needs a different formula, F 75 or F100 until the appetite comes back.  He took it.  (Hey, who doesn’t like a Bit-O’-Honey?)  We will watch him on the P’N for as many days as his family will let him stay or until we see reversal of the kwashiorkor.  Unfortunately, this is a bad disease because it may have associated organ damage, like kidney disease also.

This afternoon we will see another index case from last year, Harriet at Amani Orphans Home Mbigli (AOHM).  She quickly recovered and was growing well and developing well last summer when last Birdie and I saw her.  She should be about 2 years old now.

For my friends and fellow parishioners at St. James, I got simple preliminary plans for the dispensary enlargement at Idunda.  Perhaps I can photograph it and put it on the blog.  Dr. Saga is going to send rough budget plans for it too.  Off to class for some learning!  Done.  Three great lectures:  Post Exposure Prophylaxis for HIV (Ally Liou); Geology of Tanzania (Moody); Proverbs of the Hehe (MwaMoody).  Who is MwaMoody?  Kihehe for Dr. Gary Moody.  All three were terrific.

We went to Amani Orphans Home Mbigili this afternoon.  And folks were enthralled. The children danced and sang for us.  We toured the campus and looked at the farm.  They have cows, pigs, chickens, rabbits, turkeys and probably others.  They are getting electricity soon, but they are already nearly self-sufficient.  They make biogas from the cows’ and pigs’, uh, uh, oh yeah, manure and are able to do their cooking with methane. They grow a nut for biodiesel also.

My little friend Harriet looks good.  She is a bit shy around strangers, but a live-wire otherwise.  Our friend Beate from Amani asked us to look at a couple kids with interesting problems.  We may have helped.  I hope so.  I should find out before I come home.


Tuesday, January 15, 2013

To say Tanzania is "everything I expected" would be inaccurate. I knew there was no way I could prepare myself for this experience, though I tried.. hard. I tried to imagine the breathtaking scenery, I tried to imagine the infectious energy of the Tanzanians in their joyous, "haberi," greeting, I tried to imagine the smells, the sights, the feelings of Tanzania, but I couldn't. Until I stepped out of the airplane. "Africa," was all Ken needed to say to nearly bring me to tears, which would later slowly stream down my face on the bus to the hotel, overwhelmed with joy that the magnet pulling me to this very spot could finally rest. I was finally breathing the thick air, hearing the symphony of bullfrogs and crickets, and smiling so big for so long that my face started to hurt.
I still have to pinch myself when I awake to this environment. The chiming bell outside our guest house wakes me up at 5:45, followed by the roosters close to six. I begin my morning with a run down the valley, waving to the farmers in their "shambas" hoeing their fields, or a yoga sequence on the front porch, performing sun salutations to the rising sun over the mountains. It is truly surreal. Our cook, Ana, prepares a delicious breakfast of doughnuts, perhaps eggs, fruit, and something else fried, in which we all manage to comment on the "carb content" every time, though happily ingest all of the deliciousness.
Hospital rounds begin soon after that. We all shuffle behind a lead Tanzanian doctor who guides us through the patients, their current condition, and how they are progressing. This part of the day is obviously a wealth of information for me, as I scramble down as much medical terminology as possible while trying to contain my emotions. This entire experience has been such a roller coaster of emotions, devastation, disbelief, joy, guilt, gratitude, heart break, humility, appreciation, happiness, soulfulness. In just a matter of a week, I have also spent time in the Pediatric HIV/AIDS ward, watched a C-section being performed (again, more tears of joy), helped perform a health screening on nearly 50 wives of pastors (with more to be seen on Wednesday and Friday), and simply tried to soak in the food and culture of Tanzania. 
Tomorrow will be another "Day of Grace" health screening with around 50 more women where I will help take blood sugar readings. This weekend we wil head out for a Safari!
Tanzania could not be "everything I expected," but it surely is everything I have wanted. How incredibly grateful I am for the opportunity and the fact that I still have three weeks ahead of me!