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!

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!

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.

Please read this from The Lancet: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2960150-6/fulltext?elsca1=ETOC-LANCET&elsca2=email&elsca3=E24A35F

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 4^th 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

-->

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.

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.

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.