Monday, May 30, 2011

Bits and Pieces

I went to the duka (store) the other day, and Dr. Makanza was there. Actually, he's there a lot lately, as he owns the store and his regular employee is gone. So the surgeon runs the store. He's probably the most overqualified shopkeeper in the world, but he says that Africans must do many jobs to survive. 

Dr. Makanza, surgeon and shopkeeper
Docs here aren't paid much, not by our standards anyway. They make about 900,000 tsh/month. Roughly 600 USD. Great by village standards surely, the average villager makes maybe 20 USD/month. Still, only one doctor has a car.  I digress.

I went to the duka to get some cookies, they have about 3 varieties, none of which are OREOs. When I got there Dr M was closing up early, because he had 2 C Sections to do. He said twende (let's go), and off we went. He invites me to most of his surgeries and is happy for me to tell you all about them. I've described a surgery in an earlier letter, but I am revisiting the topic because this is the third C Section I've observed and while all the moms are fine, only one  baby has survived.

The baby born a few weeks ago was stillborn, and had been dead for a while, so there was no attempt to resuscitate. The first baby born last Saturday was a nice size, perfectly formed, but not breathing. The cord had no pulse, and was compressed in the middle. So Habili, (nurse anesthetist) began helping the maternity nurse with compressions and bagging. 

Unfortunately, the maternity nurse was unfamiliar with infant resuscitation technique, and he had to teach her on the spot.They worked on the baby for about 10 minutes, but then the Dr. M needed him, so I gloved and helped with the babe. We got him breathing, but it was a weak effort, and he went off to the maternity floor.

I asked what else could be done for him, and they said nothing, either he would live or he wouldn't. The doc gave him a 50/50 chance. He died the next day, which was no surprise considering there was no respiratory support available after we got him breathing. Dr. M said that generally, in situations like these, they focus on saving the mom. She needs to live because there's usually too many people already depending on her, and everything falls apart if she doesn't survive.

The second baby born that evening wasn't breathing either, and one of the skinniest newborns I've seen in a while. Habili was still busy, so I helped the other nurse. We got him breathing, he even cried a little. He went to the floor, and is doing well. When I saw Habili the next day he updated me on the two babies. 

Habili's a good guy, he's also the man who drove me around on the pikipiki a few weeks ago. Like the doc said, you need more than one job here. We were talking and he said that the babies would not have died had they been born in a hospital with 1. adequate staffing 2. adequately trained staff 3. machines to support the babes and 4. better access to prenatal care. I had to agree.

It bothers me that I have so easily accepted these deaths. I worked at Kaiser in Oregon for many years, and every now and then there would be a stillbirth, or a SIDS baby would be brought in from home, and it seemed everyone in this big hospital heard about it and was affected. You could feel it in the air. People were sad.

In America it's just not as common to lose a babe or a mom, but it's different here. I don't like to think that I've become hardened, maybe I've just gotten used to it. Maybe I just focus on other things.

Please don't take what I say as criticism of the hospital and staff, I'm just repeating what was told to me by the doc and the nurse anesthetist. I think, given the circumstances here, and the lack of almost everything, they do a good job. The hospital has come a long way, and things have improved over the last few years. There's a nursing school now, and they just opened a high risk maternity waiting house. The high risk center should by a huge help, as many moms arrive too late or have taken local medicine which can do more harm than good. Also, some volunteers have arrived with new equipment. Statistics are looking better.

Another huge problem is transport to the hospital. There is no actual ambulance. There are pikipikis here to bring people in, but that costs money, and if you're coming from a far away village, even more. So people try the local medicine and/or wait till the patient is almost dead to hire transport. It's not uncommon for laboring mothers to have to stop the pikipiki and deliver by the roadside. Hemorrhaging moms, ruptured uteruses, all sorts of emergencies arrive on the back of a motorcycle, over a very rough road.

It would be wonderful to get used equipment from other countries. Certainly drug companies send all their unpopular drugs here, hence my ready supply of rohypnol (date rape drug) for sleep. First World hospitals update equipment regularly, (there must be warehouses full of useful crap somewhere). One problem is that even if equipment is sent, it might get held up at customs. Custom agents can and will demand huge bribes to release the crates, and most people can't or won't pay. Or would pay but don't have the money. Then the agent assesses a fine for storage. You can't win.

For a while when I worked at Kaiser, I was allowed to collect unusable supplies. When a patient dies or is discharged from the hospital, all the unused supplies (sterile, unopened dressings, unused IV bags) can't be taken from one patient's room and used for another patient, so are discarded. For a few years I was able to collect these supplies and bring them here. Then one year I was told the supplies would now be sold to these same countries. Unfortunately, what is sold frequently doesn't get to it's intended destination. See above.

I won't belabor the point, maybe I already have, but in essence, they aren't asking for your new stuff, just the stuff you throw out. Dr. Makanza is hoping that someone who reads this might be in a position to help out. He's a very good guy, and he lets me run a tab at his duka.
I can't think of a clever segue from infant mortality to my safari so I won't try.

I went on a small safari the other day with my friend Ruth, the wife of the hospital director. She was taking her son back to boarding school, and she invited me along. The drive involved passing through Mikumi National Park, where all the animals live. Ruth's brother-in-law has a car, and said he'd be happy to stop for animal pictures. And stop he did, again and again.

These guys are all along the road

We piled into his van at about 6 am and had such a good time. I've been through Mikumi about 10 times on a bus, and it's impossible to get good pictures, but on this day we drove slowly and looked for animals.  As it's been raining, and it's cooler, the animals are out. I prefer to get out of the car, you get better pictures. Sometimes I walk the road for a bit, a fact which was not lost on Samweli, who told me to stay away from the elephants. But I knew that.
Anyway, it was wonderful. 


We had tea at the Kilimanjaro Inn, a very pretty place with the worst service in the free world.  Don't ever go there.We were speculating as to why the waitress was so sour. We figured maybe she a) had malaria, or b) her husband left her. She was too young for c) menopause. Whatever it was, she was a migraine of a woman and so mean it was funny. 


We ate lunch at another place and it was very nice. I had the ugali and goat. I've been promising myself that I'd try ugali again, and now I don't have to do it anymore. It's the local lump of starch and that's what it tastes like. The goat was great. I like the ribs best.


On the road to Mikumi  vendors will festoon the trees with 
baskets and mats. Too lovely

John has arrived. He got here yesterday and is busy painting. Asante Mungu because I've about reached the limits of my expertise, such as it is. It's good to be working with him again. He's truly wonderful, just stands there and paints, you can sit there and watch everything emerge. It takes me about 2 days to paint an animal, and John has totally finished the background in one. Folks stop by to watch. It's a relief to have him.

saw this chameleon on the way to school the other day

We have ringworm, by "we" I mean half the kids at the chekechea. I noticed it on Susie the other day, and in anticipation of its rapid and inevitable spread throughout the ranks, I got some ointment for my first aid kit at school. Not much in the kit, bandaids, antibiotic cream and some nail clippers for mani-pedi day. We have classes on Friday till break then Martha plays games with the kids while I trim their incredibly dirty nails. 

As promised in the First Aid books, the ringworm is spreading about as quickly as it can, so I went to the lab and got some of the camera film containers they use for urine and stool samples and put ointment inside and gave them to the kid's moms. All will be well. Not to worry, I used clean film canisters.

One day Im going to write a book on all the stuff Africans put on a bicycle.
Once I saw flats of eggs stacked like this, 4 feet high. Amazing

Still hammering away at the R and L issue, as well as thirty, forty, sixteen ( or sikisteen), thirteen and fourteen. Samweli has no top or bottom front teeth so when I demonstrate where to put his tongue he spits all over me. Good kid that he is, he turns his head, so now I can't see where he's putting his tongue.  Asante Mungu this is usually the worst problem I have. 

Life is good. Nakupenda

Monday, May 9, 2011

What I Did On My Likizo

Likizo is a vacation, and I have just returned. It was sort of a working likizo, but that's ok, I don't vacation very well anyway. Besides, I'd be hard pressed to figure out what I would be vacationing from.

I needed to update my visa, so I did like I always do and went to Malawi for an overnight at the Beach Chamber. This is a little place not far from the border, right on Lake Malawi. The rooms are nice, there's a TV with three stations, and the beer is cold. Usually I get there before dark so I can watch the evening over the lake, I have a beer or two, eat some fried chamba fish and cross back into Tz. the next morning.

Evening on Lake Malawi

Traditionally there's more than a little angst surrounding my visa runs, because there's more than a little angst between me and Immigration. This has been going on since my first trip to Africa in 2003, I guess I'm just on their radar. Most times they try to get me to pay extra, sometimes I say the wrong thing, but there's always something. I'm not sure Carlee will even cross a border with me again, and I don't blame her a bit. Anyway, I was determined to make this run a smooth one.

Local fisherman going to set nets.

The trip to Malawi was uneventful, and while we waited in Tukuyu for passengers both human and fowl, I smelled nyama choma. Roast meat. There's men here who make a living selling meat sticks, and they cook them on site with little portable barbecues.They cost 200 tsh, about 25 cents. They smelled divoon, and despite my promise never again in life to eat street meat, I had a few. Very tasty, not sure if it was beef or pork, but it was fingerlickin' good and then the bus took off.

Portable Barbecue. Nyama choma tamu sana.

I arrived right on time, the lake was lovely and the fishing boats were out. It's really beautiful. I had a cold Carlsbad, and took a mess of pictures. I ordered my fish and rice and went back to my room. The fish came about an hour later, but it was very good, and I ate everything but the bones and eyes.

More fishermen

Whether it was the meat or the fish, I'll never know, but I spent a good part of the night washing sheets and running to the choo. Most third world travelers have their diarrhea and amoebic dysentery stories, and unless you have your own, it's not too much fun listening to others. So I won't go into details. Besides, this wasn't a particularly interesting tale, my Losing Control Of My Bowels in Ghana story was much better. Siku nyingine (another day).

Rice season in Malawi

Anyway, after a rocky night most of my angst during the return into Tz centered around whether or not I'd get across without humiliating myself at the visa stamping office. But zote was nzuri. As well as unwavering sphincter control, the border guard recognized me from 2 previous crossings in 2008 and grudgingly stamped my visa without once asking me for cash. I have been more joyfully remembered by other people, but oh well, an updated visa is an updated visa.

With my passport in hand and a song in my heart I  continued on to Mbeya. I've got kids in school there, and other places, so it was time to check up on them, and pay school fees.


1. Batizo is doing very well at Mbalizi Nursing School and will graduate high in her class this July. She'll be a trained midwife and will have no trouble finding a job. Asante Mungu.
2. The doc from Idweli is doing well in Iffakara. He's a Clinical Officer but taking advanced training for 2 years so he can be a District Medical Officer  and work in a hospital and perform surgeries.
3. Christina and Martha finished St. Aggrey School and are now enrolled in Shukrani International College in the Soweto district of Mbeya. They will study Business Administration and Office Management. I'm very familiar with this school, my friends Chris and David started it, and it has a good reputation. Their graduates get good jobs.
4. Violet, Ahadi and Rosie finished secondary school but didn't do well on the exams, no surprise.  I've talked enough about the schools here. But they hopefully will go to VETA, a govt. run vocational school, and will finish in 2 years, with a certificate, and be able to get work.
5. Ramadan did well on his exams and we will try to get him into a school in Mbeya where he will get a law certificate. This is the frst step toward being a lawyer. He's a smart kid, so why not.

Amalie and kids.
The two small ones are hers.

While I was in Mbeya, I stayed with my friends John and Kay, who are missionaries, but the down to earth kind. They've got a little Massai daughter they adopted from a very bad situation, as well as electricity, a real shower with hot water and a microwave. Kay also has a preschool in her house, so when she asked if I could find John Chota (the artist Carlee and I worked with in 2008-2009) I made a few calls and we started painting her chekechea. 

I'm back in Berega now, but John will finish her school then come to Berega to finish ours.
When no one else is around I function as an artist, but when John is painting I usually do most of the prep work. It's a waste of his talent, and he hates it. I don't mind it too much, plus I get to watch and learn.

This is why I do the prep work.
My boats are recognizable as boats.
His look seaworthy.

I visited Idweli, the little village where I lived in 2005. Amalie, one of the girls from the children's center now has 2 kids, no husband and no job. So I made her a micro loan and she will make chapati and maandazi (fried dough balls eaten with chai). 

Mama Jackie (the doc's wife) will advise her, and hopefully it will work out and maybe she can have a little restaurant or tearoom later on. It's got to be better than what she's got now.

So after about 10 days I got homesick and returned to Berega. I rode up to Mbeya on Abood, a bus company I'd heard drove at a moderate rate, which was a lie. So I investigated a little and went with Sumry on the way home. They drove just as fast, if not faster, but the seats were nicer and they had a Bollywood movie (which you couldn't hear over the roar of the bus engine but you can't have it all).

Where all the buses stop.
There's food and toilets and you can buy all
your veggies on the way home.
But you only get 10 minutes
until the bus leaves.

Mbeya is in the southern highlands, so while the ride up was often uphill, the ride home was downhill through the mountains. I tried to concentrate on the scenery, hoping it would distract me from the grinding of the brakes as we screamed around the curves (and the smell of burning rubber, don't forget that). The view was outstanding. Most people don't realize how the climate and environment varies in Africa.

We passed through Mikumi National Park going up and back, and as it's rainy season, there's lots of grass and lots of animals eating it. I saw herds of zebra, giraffes and elephants.Tried to get good pictures, but at our rate of speed it's not easy to get and/or stay focused. I never asked the driver to slow down, I figured he wasn't too concerned whether we lived or died on the road so why should he care about the quality of my pictures.

Large bag of dagaa.
It went with us in the taxi to the border,
and stayed in my nose hairs for 3 days after.

So now I'm back, resting up from my vacation, doing a little painting. I have to say, all the stuff I've been drawing looked better before I sat around and watched John. He should be here next week or so, and I'm hoping he doesn't walk in and tell me, "I can fix it."

All the packages that you've sent have arrived, so we've got some fun stuff to play with on Monday when school starts. I've tried to teach the kids to say R and L, eventually gave up and started saying ara and elu, just to be understood. BUT when I was in Mbeya, I noticed that ALL the kids at Kay's school can say both R and L properly so come Monday these kids are in for a surprise. It won't be easy, these are village kids, not city kids, and many of Kay's students come from Zambia, where they speak English. But in the end, I will prevail. 


It was good to come home, Africa is a very welcoming place, everyone was smiling and asking if I had a good likizo and Pesaka (Easter). Mama Freddy, one of my adult learners and mother of one of my preschool kids (Freddy) came to my house with a zawadi za Pesaka. An Easter gift. She brought me a chicken, a nice fat live one. She is keeping it for me at her house, as I am ill equipped to house fowl. But his housing won't be an issue after tomorrow, because we're going to eat him with rice.

My Friend Mama Freddie
with my chicken, who was truly delicious
You need to understand how special it is to be given a chicken. Folks are poor here, and chickens are expensive, so I was very touched. This is my second chicken, I was given one in Kyela a few years ago. That we will eat it together is even better.  Isaac said there's an old Swahili saying, Mgeni njoo, mwenyegi apone. Roughly translated it means the guest comes, the host benefits. As we will share the chicken, it's a win-win.

When I was a kid I wondered if I would even live to be this age and if so, what I would be doing. So at 60 I'm traveling and learning a new language and culture. Life is too good.