The Butterfly Tree

I was walking to the hospital the other day, ever mindful of bikes both pedaled and motorized (in Africa the pedestrian is not king, and the customer isn't always right either) when I heard my name and there, sitting under a tree drinking a 7 UP, was Dr. Makanza (GP and general surgeon). We got to talking and he said he was on his way to repair a ruptured uterus. I asked if, in the future, I could watch an operation and he said, "Even now, you can come".

So, I went into the dressing room and put on a surgery dress and a pair of rubber sandals. I could have opted for rubber boots, but they looked hot and I figured I wouldn't need them, although those at ground zero did.

Out in the hall was a 31 year old woman, who was in her seventh pregnancy and has one living child. Apparently she's from one of the outlying villages, where she labored for 2 days. During that time, one of the local ladies/village midwife, who knows, gave her some "local medicine".This particular local medicine is made from the bark of a certain tree, and when distilled, is put into chai and given to the mother to drink. It acts much the same as Oxytocin (for the very few non nurses on my email list, a drug that promotes and/or strengthens contractions). A sad side effect of non judicious use of this local medicine is a ruptured uterus, which is what happened here. She already knew her baby had died.

So, they started her up on some IV fluids, (which are made here at the hospital), and inserted an NG tube (which drained into a rubber glove). While she waited, the doc, a nurse anesthetist and 2 nurses scrubbed and gowned and prepped the room. There was no monitor, but there was an older style respirator, and a suction canister for when the patient arrived in the theater.

First you cut up a large plastic bottle and hang it from the pole. Then you place the IV bottle into it and insert the spike through the hole in the bottom.

They wheeled her in, and put her on the gurney. Then they took a 3 foot 1x4, put it under her back, and secured her right arm to it, ditto with her left. She looked like she was being crucified. Me, I was just observing and tried to stay out of the way.

They disinfected her, draped her, made an incision into her rock like uterus, and delivered the baby. After which they pulled out some fist sized clots and repaired the tear in her bladder and uterus. The floor was pretty bloody by now, I was rethinking my choice of footwear.
It was much like any surgery anywhere, everyone doing their jobs, talking, laughing occasionally. But without all the equipment found in the First World. And with the screened in windows open for a breeze, and the occasional fly. Per Dr. Kaneno, sterility is impossible, so rural African hospitals combat infection with antibiotics rather than prevention through aseptic technique.

Very hot in the room,even with the windows open, and like anywhere else, the circulating nurse was in charge of sweaty forehead wiping. But after she wiped the docs forehead, she tucked the gauze in the back of his surgical gown, up near the neck, and used it throughout the procedure. Waste not...

Sometimes I miss medicine; the patients, the toys, the wounds...so I occasionally hang out at the hospital looking for interesting stuff, and the docs are happy to show me around. Dr Makanza took me to see a young boy, about 13 or 14, with an ileus. Apparently he had malaria and was given another "local medicine". I have no idea what it's called, but what it did was to paralyze his gut. The poor kid had an NG tube, and a huge abdomen. Dr Makanza thumped it and it sounded like one of those kettle drums they make in Bermuda.
Folks go to local healers because 1. they're near, 2 they're cheap and 3. they've always gone to them. I imagine that some of the treatments work, or maybe the pt would have recovered anyway.

When the local meds don't work, people eventually come to the hospital, and frequently it's too late. The mom with the ruptured uterus is fine, but the baby wasn't. There's no ambulance, except for some men on motorbikes who transport for a goodly sum. It's an option, but not every sick person can stand the transport up the windy, rocky,hill, or pay for it.

The hospital is ridiculously understaffed. Sometimes at night there's only one nurse for the whole 140 bed facility. All patients require a caregiver to cook, wash bedding, and assist with care. This is usually a relative. As well, people here don't have a 5 page med list, the  only meds they receive are the ones that they need while in hospital. So this frees up the nurses for other things.

I was in the village last week and I saw Christina, one of the local kids. She was limping and looked feverish, and when I looked at her leg it was swollen and hot and clearly infected. I talked to her sister and told her I would take her to the hospital. The doc incised it and you wouldn't believe the amount of pus that poured out of her leg. Anyway, graphics aside, the doc visit, the I&D and meds came to $21.90. This isn't much for me, but her mother could never have paid, and she would have only gotten worse. Infection counts for a huge percentage of deaths, especially in kids. She's fine now.

James and Eli in lab draw area

I visited the lab, which didn't take long because after I saw the 2 microscopes and the reagents, that was about it. There's 3 people working there, and lots of labs to draw. They draw and run all tests on site, so it's busy. I sat and talked to James and Elly and found out that malaria and typhoid are very common. I knew about the malaria, but the high incidence of typhoid is kind of scary. I had typhoid in Ghana, and really don't want it again. I don't think I've ever been so sick.

STDs are rampant well, but not among the Massai. Lots of anemia, borderline or otherwise, mostly from bad diet and repeated malarial infections.

Part of the lab, you can see the reagents on the shelf

Specimen cups. Aim true.

I was in the lab talking to James and Elly and next to me was a big box of plastic film canisters. So I asked what they were used for and James told me that they are are specimen cups, donated by kindly photographers. ME: What kind of specimens? JAMES: Urine and feces, of course. What do you use in America? ME: Specimen cups. JAMES: Aah. We don't have them here. ME: I can see that.

When I talk about the hospital, please don't think I'm complaining or putting them down. But I always try to tell the truth as I see it. And this is how it is. And in spite of everything they do a pretty good job. They do the best they can with what they have, or or don't have.

I've been playing with my new camera, and it's too much fun. It's a little cumbersome, so mostly I sit on my lanai and take pictures from there. Fortunately for me, there's a lot going on off my lanai. Mostly flowers and butterflies, and the occasional cow or herd of goats.
I was walking around the house, trolling for interesting stuff, and I saw a tree in my front yard that was covered with butterflies. Maybe not covered, but there were about 50 of them, so this must be an especially sweet tree. I tried zeroing in on specific butterflies, but if you've ever tried to follow a butterfly with a camera... Eventually I just trained the camera on a likely looking flower and waited. And they came. Life is good.

Playing with my new camera

I've said it before, I live in a NatGeo special. All day and night I hear birds, and in my mind they're lovely and exotic. Im trying to hunt them down with my camera but they always seem to be in the next tree. However I'm as determined as they are elusive so its only a matter of time.
I love it here.There's always something new and different. I went to the duka (small local store selling lots of little things) the other day, and the owner was leaning over the counter, gossiping and sharing a udongo with a friend. Udongo is a small piece of compressed dirt that looks like a piece of chalk. Ive tried one, chalk tastes better. The local ladies like them, though, and probably get lots of minerals they dont get in the relatively nutrient free village diet.

Chekechea is fine, always fun. The kids are learning lots of words, numbers and letters, they just can't affix them to a specific object yet.  I showed them a 5 and asked what number is this and I  got sixie, three, fish...just throw something out, you never know when you might get one right.Peanutwise, were up to 26, which looks like about all the average five year old can hold in his/her right hand. Its all fun, and we've got 2 years. I think they'll be in fine shape by then.
So for the next 2 years, Mungu akipenda (if God wishes), all I have to do is teach English, work on my Kiswahili, take pictures and hang out here in the tropics. 


Life is too good.


Nakupenda. Mama Liz

There are 2 of these wooden bikes in Berega, and they work.

 I'm finally over my obsession with chickens, replacing it with butterflies

rainy season has arrived so the crops are watered and the kids have mud to make phones 

From the veranda

Where I hang out. Life is good

Making lumpies

It's not some kind of local delicacy , it's the Berega version of a smoothie. 


I bought some pineapples and mangoes and they were starting to rot in the heat so I cut them up and dumped them in a container. A previous volunteer had left a whisk so I smashed them and it's delicious. That's a lumpy. I may open a stand. And maybe the heat has gotten to me.

The view from by back porch. I'm a lucky mzungu






















My house

Our checkechea (preschool) is growing, we have 3 more kids this week, which brings us to 9. But remember, this school costs 200,000 tsh/year. That's about 200 USD. Which puts it out of range for more than 90% of Beregonians. They're kind of a wild group, our checkechea, but then no one has ever really asked them to do anything but cut grass, and run around the village.




Also behind my house
























We begin our morning with greetings, and then the days of the week. They do know most of the day names, but not in any particular sequence, so everyday Bea hollers out "TODAY IS SUNDAY." Every day. If we tell him today is Wednesday and then ask about tomorrow he says, " TOMORROW IS SUNDAY". We  call him Pastor now.The same with numbers and letters, they just holler out anything. It's a process.

We have snack time at about 9:30. Most people here only eat once a day until harvest time, so it's a hungry group. I buy peanuts and they bring water. The have to ask for the peanuts, as well as the desired amount, in English.

By the second day Mbuli had it all figured out and asked " Teacher, may I have 10 peanuts?" Today he asked for 19 peanuts. I don't think we're planning to teach them much past 30.

Africans don't drink much water, as a rule. Isaac said they've grown used to not drinking, water being frequently scarce and/or dirty, so hamna shida. But we asked the parents to send the kids with a bottle of water for break time. I guess no one has told the kids that they're accustomed to not drinking, because they seem thirsty enough and chug it right down. Angel and Christina have peed on the floor already, and Jennifer just made it to the choo (toilet) today.

We're considering a feeding program for the morning. It shouldn't cost too much. I hate watching the little kids fade after an hour or so. I may be making a shameless plea for funds soon. (remember those?)

I have 6 afternoon students now, all at different levels. It would probably help if I was an actual teacher but oh well. When you have to start with hello, I figure I can't do much harm. Besides, it's free.

So we learn to speak by speaking, identifying body parts, naming household items, asking questions. That's how I found out that there's only one meal a day. I asked Waziri (my star pupil) to describe his day in English and I was prompting him. I asked what he had for breakfast and he said nothing and I asked him why and he said because there was nothing. Another loaded question is how many brothers and sisters do you have, because then I find out that Neema's brother has died. There's no safe subjects here.

You may recall from past trips my fascination with chickens. Nothing has changed

I went up to the village yesterday to take pictures of the new school that's being built but got distracted by some women going to fetch water. I asked them how far and they said "not far." Just over there. For those of you who haven't spent time here, never ask an African how far something is unless you're in a car.

So I decided to go with them, and they asked me Unaweza? Which is Kiswahili for can you do it? Ignoring the so generously given clue I said Ndiyo, ndiyo, nataka mazoezi. I need the exercise. It was a good half hour in the heat, over hill and dale, gullies and rocks . I don't know the temperature, I never like to ask. I try to convince myself that it's cooler than it is, which, by the way, doesn't work. The pictures will tell you much more than I can say. I had some water with me, but in light of what they were pulling up out of the sand I couldn't bring myself to haul out my brand new bottle of clean, store bought maji.

African women think wazungu women are generally rich, weak and spoiled, and I'm always trying to convince them that we're strong and able. We can wash our clothes, dishes, all that crap. They're surprised that as yet I haven't hired "a girl" to cook and generally pick up after me, but I watched a woman put 3 buckets on her head and I had to concede.


What can I say??

 Note the mtoto on her back.



















I know I spend a good bit of time talking about water, but it's a big topic here, except among the men, who don't fetch water. I won't go into how I feel about that as I've already made myself VERY CLEAR ON THAT POINT MANY TIMES ALREADY. I did mention to one of the men that if they had to fetch water there'd be a faucet right in the middle of the village. He was less than amused.




Where the water comes from. 

What the water looks like. A few minutes after I took this picture, the kid drank this water.

























Got a marriage proposal the other day. I was walking to work on Monday and this older Massai man ( loads of Massai in this area), was talking to me and asked where my husband was. When I told him I didn't have one he smiled and offered himself to me so I wouldn't be alone anymore. Massai traditionally circumcise their girls so they can be proper wives, but if you marry a Massai and are not Massai, you are not required to surrender your genitalia. I told him bado (not yet). Besides, at my age I wouldn't fetch much of a bride price. Then there's the fetching water on my head thing. All in all, it'd probably be best if he married someone else.

The Massai live around here, so you can see them in various places. From childhood, I remember looking at the NatGeo and seeing Massai herding cows, jumping in the air... But progress comes to us all, sooner than later. I've seen Massai on motorbikes, at bus stations, and of course, herding cows. They're an interesting group, and I've been invited to visit a village one of these days.






Like I said, progress will arrive, note the phone.

 Massai guy, not the one who wants to marry me.


























I observed a surgery today, a ruptured uterus. That's an entire email unto itself, so bado.

I hope everyone is well and happy, I'm fine. Life is good. It's cooled down enough to be hungry, so I'm going home. 


Went to Morogoro yesterday, the big city, and bought cheese and butter. Got home just before they were irreparably melted, so there is a cheese sandwich in my future. That and a lumpy and I'm good to go.

Nakupenda. ML

You know when you've arrived when they have your picture on gum. I've seen his picture on T shirts, kids clothes. Somebody email him, please, I'm sure he'd be gratified that no matter what his approval rating is in America, he rocks in Tanzania.