Things I will Miss--:(

1)  Power cuts and using a head torch for everything
2)  Cold showers...because my house didn't have warm ones
         2a) 2% water pressure showers...only did those on the dirtiest of occasions because the water
                 was cold but constant
3)  Bucket showers....using a bucket filled half with cold water and then the other half with
                                         a kettle of boiled water if there was electricity or gas boiled if not.  Then
                                          use a pail and pour over yourself.
      ***3a)  bucket showers by candle light, happened once when power was out and it was the
                    most unromantically romantic shower that I ever had!  :D

4)  Squatting toilets! 

          4a) Squatting toilets without toilet paper!  Had to carry toilet paper wherever I went
                   because the odds of a toilet stall with toilet paper was slim and it was always a delight
                   when there was some!
          4b) Squatting toilets, or any toilet really that you put water down to flush! And to save
                   water use the old saying "if it's yellow let it mellow, if it's brown then flush it down"

5) The word Mzungo...shouted at me wherever I go, as annoying as it was then I kind of miss it
                                            already.
6) Greeting people!  In the typical fashion:   "Jambo!"--> "Sijambo" or and more commonly:
               
               person 1= "Mambo"  (how are you)
               person 2= "Poa, vipi?"    (I'm fine and you?)
               person 1= "Safi! or Poa! or Nzuri!"     (fine)

        6a) and you are always fine even if your feeling the worst and your arm is dangling off your
                body and your parents both just died, you are still fine.
        6b)  and everyone always greets everyone, even as you are walking past them you continue
                 the series of greetings until it is finished although the original person is already several
                 meters past you by then....never really understood that one.
7) Little children smiling and greeting you.
            "Hello"  me: Hello
            "how are you?" (in their cute swahili accents)   me: Good thanks! and how are you?
            "Fine!" and that's sometimes as far as their english goes.
        7a)  and then you'll sometimes get cheeky ones that continue with:
                         "give me you money" "give me 100 shillings" with their open palms stretched out

8)  Grass cutting:  using machetes, but they do quite a good job.

9)  Single cows and/or goats tied up on the side of the road eating their patch of grass.

10)  Washing my clothes outside with hand soap and buckets of water, then hanging them on the
          bushes to dry.

Among so many other things...and I'm not really kidding about this list, I do quite miss all of this even though they are so unusual but that is why I enjoyed it most!
          

24th June-Last Day :(

       Yesterday Niamh and I checked up on baby James to see how he was doing one day later and he was still on the nasal cannula.  Not good...and his breathing sounded so raspy and not in a normal rhythm.  The nurses say he was probably brain damaged from lack of oxygen while he was stuck in the birth canal.  So sad.  We asked the head doctor what he planned to do about the baby, because he can't just stay here on the ONLY oxygen machine that we have.  He needs to go for tests and such and be on oxygen for a while it seems like and for that he needed to go to Mt. Meru Hospital in Arusha, the same one we took Seamus the other night.  He said he'd put a transfer in after he performed that days C-section and we asked to be let known when he'd be going.  After about an hour or two all the papers were completed and we got to drop little James at the hospital in Arusha as well as two twins born a few days ago.  One of the twins had severe pneumonia, and the other had that as well as sepsis.  The twins stayed in a paediatric special unit while James went to the NICU, where we also cheekily checked on Seamus.  Sad story that we couldn't find him at all and the nurses were completely useless saying they had no idea where he had gone and didn't even know of him.  So odds are he must have died, just a shame we'll never know.

    Today I got to do my first casting, wrapping a foot and an arm today.   Also cleaned and dressed some wounds in minor theatre.  Pretty exciting! Very mellow last day and it was kind of sad to be leaving the doctors.  Had to say my goodbyes today, by this stage I had really become quite comfortable with everyone and had the routine down.  I just wish I could have stayed longer!  My plan is to come back in three years, hopefully after having one year of medicine completed.  I can't wait.  Atleast now I can 100% say that I want to do this type of medicine: helping those who don't have access to good equipment or can't afford to be looked at or can't afford gauze, ointment, or their medicine, all of which the patients have to purchase themselves PRIOR to treatment.  I'm gonna be back!!

Outside the hospital entrance on my last day.

Sunrise leaving Nairobi airport for London.

22nd June--A Bit of OT Time

      Soo...after only about 3hrs of sleep from the night shift last night I left to meet some volunteer friends to go to a house in Arusha of a family with a special needs child.  Originally there was supposed to be a group of them, but the others couldn't get transportation that day, so there was just one girl.  She was four years old with what seemed like cerebral palsy and I'm sure something else seeing as she couldn't speak either.  She could hardly hold herself up and she couldn't control her movements.  We came to play with her and give her exercise so that her grandma (primary care taker) could do other things for a couple hours.  The whole family was there and they were so happy to see us come, all chatty and smiling and wanting to talk and they were fantastic with the little girl, making her laugh.  I wish I was better with names, I can't remember the girls, but she was so strong! We'd try and stretch her legs and do bicycle movements and arm circles and she'd just pull them tight as she can to her body.  Eventually she'd ease up and then getting her to laugh was so cute!  So much potential.

    She reminded me a lot of my sister who has cerebral palsy and hydrocephalus.  At four, my sister wasn't doing much for herself either and I don't think she was talking a whole lot, but she atleast was going to therapy and had a wheelchair and later a walker once they got her to hold herself up.  If only this little girl could have any of this.  At the moment, it was up to her grandma/aunt/siblings and family to do the therapy for her and let's not go extreme and even think she has the chance of getting a wheelchair..cause she doesn't.  In Tanzania, the handicapped are looked down upon and are often hidden away or put into institutions or some get placed in special schools which is great.  I'd like to come back again and do more work with special needs kids here, organise a play date with several off them, help to pay for their transport cost and feed them lunch.  So much more that I could do and yet I leave in four days...arghhh  :(

    There is a really good cafe that we frequented a lot in Usa River, about a 20 minute walk from my house that is actually a place that houses and teaches handicapped people a skill or trade that they can use to benefit others and help support themselves.  The cafe helps to give money and it also provides a job for some of the people who live there as well. It's called Tanz-Hand's.

http://www.rehabilitation-center-tanzania.org/index.php?option=com_content&view=article&id=67&Itemid=121

22nd June--Delivered a baby!

Best night shift I've had, way to end my final week! :) so pleased. 

      Me and one other volunteer on last night, Niamh (pronounced Neeve) from Ireland and already completed one year of undergrad medicine, with two nurses.  Was so hands on last night, admitting patients, checking saline drips and administering IV/IM injections when needed, changing catheters and emptying their bags when full.  I tried to be as helpful as I could even with the language barrier and the mums were really patient with us as well. 
     Such an epic night. Ok first off, many deliveries. I even got to help with a lot of them from holding the head and making sure the cord wasn't around the neck to tying the umbilical cord to cut it, to learning how to deliver the placenta...all with supervision ofcourse.  There were three complicated births. 
    ONE:  young mum, having trouble pushing the baby out to a point where she was just quitting trying to and the baby's head was half out.  The poor thing had to have been stuck in the vaginal canal for over 10 minutes and green/brown liquid was leaking out from where the baby was excreting...the sad thing was that it was also the same liquid that the baby was probably starting to inhale.  The nurses were getting so angry, telling the mum in swahili that if she doesn't keep pushing she is going to kill her baby! But the mum didn't seem to care all that much, the baby finally came out lifeless and the mother stayed as long as she needed to and then wrapped herself in her kanga and went to her bed, she didn't really even bring enough kangas to wrap the baby to keep it warm.  Such a shame.  So the nurses were trying to resuscitate the baby using the only oxygen machine they had, and a hand held pump that hardly worked right.  Often the nurse or Niamh would squeeze the air bag and nothing would come out as if there was a leak somewhere, meanwhile the baby is still not hardly if at all breathing.  It was so worrying to watch and super frustrating too because of the tools or lack there of--Niamh and I were getting so involved that if this baby had died because of technical failure, we'd have been so angry!  Eventually he did finally breath on his own consistently after about 20+ minutes of working with the stupid machine and chest presses...pump 1-2-3 squeeze.... ended up putting a nasal cannula in after a while. Who knows though how much damage he had :( Named him James!
TWO:  The next troubled case occurred during the resuscitation of James, where a premature baby was delivered at five months.  The nurses swaddled him with blankets and left him on the table with the other baby but didn't do anything for it.  It was so so teeny and wasn't breathing but I felt so bad that they were just leaving it there and not trying to get it to breath.  Their explanation is that it is too early and there isn't a chance it will live anyways. But there is a chance! If it can be stabilized and then sent to a larger hospital there is always a hope! So I decided to rub his side just to see what he would do, and then I got a gasp!! I wasn't sure at first but then he did it again after I kept rubbing and my partner Niamh saw it too, we got so excited.  She put the oxygen pump on him, sharing it between the new baby and James.  I kept rubbing the new baby's sides and started chest compressions and then the gasps, all that they were, came more regularly.  The little guy was trying!! We named him Seamus (yes I know it means James too, that was the idea) after about an hour of this, we tried to plead with the nurses to allow him to be taken to the bigger hospital in Arusha town where there is a NICU that deals with premature births.  We said that we'd pay for the transport, we just want to give this baby a chance! and the mum and grandma was so worried too, they seemed to actually care.  After a bit of convincing the nurses finally agreed and we woke up the night supervising nurse to fill in a transfer form to go.  Riding in the ambulance was exciting, going who knows how fast in the middle of the night (about 5 am at this point) and arriving at Meru Hospital in Arusha, took us bloody ages to find the right place once we got there but we did and handed little Seamus over in hopes that the NICU would be able to provide much better care.  They intubated him straight away so we just hoped for the best.  At least he has the best chance he's gonna get in this part of Tanzania by us delivering him to Arusha, the nurses would have just left him to die at our hospital in Tengeru. 
    To be fair they do what they can.  If they don't think a baby will live, why waste LIMITED resources on those cases?  I mean throughout the whole night, we have been using sterile surgical gloves for the smallest things just because the maternity ward ran out of disposable gloves.  Just makes you realise that hospitals here really DON'T have a lot, but they do what they can. 
THREE:  The final complication was when a women came in with twins, one she delivered at home and the other she delivered in the hospital, but the second had come out all white and not breathing...it wasn't going to live, it just looked dead.  But the nurses tried their best to resuscitate this one since it was full term, and it just didn't work.  Meanwhile another birth happened, so on the table with the heat lamp made for two babies, there were five.  It was crazy!!

By 6:30am it was about time to clean up for the day staff, meanwhile another women was starting to give birth.  She had been on the birthing bed for a bit of time and I had gotten the supplies ready for the birth:  10mL Oxytocin, pair of scissors, hemostats, cord clip and the kanga.  Went to clean and then came back to check on the mum and the baby was crowning! I called to Niamh to come help me cause I was delivering the baby, it was coming now and the nurses were either sleeping or busy.  So Niamh had the head and shoulders, it was her turn, and I tied/cut the cord and delivered the placenta.  We did it all ourselves!! The nurse came to watch briefly to see that we were OK and then went back to cleaning.  Hehehe it was AMAZING!!  Such a good finale :D

By 8:30 we finally went home, we were knackered but so so happy that we did the night shift last night.  I think I'm going to remember this forever.  I learned/witnessed so much!

21st June --- Celebrity Mzungo!

    I spent the weekend with four of the other volunteers camping on Pangani Beach.  Very nice and relaxing!! Saw the moonrise--didn't know there was such a thing and beautiful sunrises.  Lovely strolls on the beach and got asked to marry a Muslim tour guide who was in his late forties one morning, but I told him all about my lovely (and really non-existent) boyfriend back in Scotland who gave me this engagement ring on my right hand ring finger...he understood.
   Back to work this morning, didn't see much, it was unusually a SUPER quiet day.  Good! that means less people having problems.  Jumped about the different wards to see bits and pieces of everything but went home around 12.30 so I could sleep a bit before doing the night shift tonight.  On the way home though I was riding the dallah-dallah and the only white person of course in the vehicle, greeting by "Mzungo! hello how are you?" I answer and the two door men start speaking swahili to each other, look at me and then continue to speak, every now and again I'd hear the word Mzungo and know that they are definitely talking about me.  And then they'd start to laugh and then the passengers in front of me would look at me and smile, I had NO idea what they were saying.  More swahili spoken amongst several passengers now, laughter, and theeennn the two passengers AND driver turn their heads from the front of the dallah to look at me and smile, talk about AWKWARD! jeeze...eventually the guy next to me decides he'd be nice and tell me what they are saying which was that the one door man would like to talk me for a drink.  Who knows what else was said but I replied thank you for the compliment with a smile  and got off a the next stop...(I was at my destination, not just being rude) such a funny situation! haha only in Africa :)

Witnessed a circumcision today, poor kid sounded like he was being murdered! The doctor gave him a local anesthetic, but it should take 20 minutes for the effects to kick in, but the doctor decided it's good to go straight away and away he went!  Jeeze I probably would have gone mental too if I were the 6 year old.   It looked so messy and horribly stitched but I haven't performed one so I can't say that it was.  I was just the iodine pourer.  Then after the boy, a women came in with a huge abscess on her arm from a tetanus shot.  When there is no external opening for an abscess, it is termed a sterile abscess.  The doctor cut into the area and he asked for an assistant, which I gladly volunteered, to hold the tray while he squeezed the pus out and then he swapped positions, allowing me to do the squeezing. It was insane how much pus this women had in her arm, holy cow it just kept coming! Then the doctor would dig around with a pair of scissors to free any blockage and then more pus would come out until finally I hit just blood.  Then it was just a patch up with gauze, some iodine and she was good to go.  Pretty exciting stuff!

15th June--The Night Shift

The Maternity ward.

 
    I did my first night shift last yesterday night and last night (Monday and Tuesday night) from 6.45pm-7am.  It is now Wednesday morning and I'm heading to bed after I write theses notes.  I really really liked the night shift, it was me, one or two other volunteers and two nurses in the maternity ward.  On the left hand side of the ward there is a room for expectant mothers, in the centre are three bed for birthing and exams, and then on the right is another room for post-birth mothers and their baby. 

Monday night: me + one volunteer.  There were 5 births overall, my first time seeing a live birth and all that comes with it including paper work.  I observed several pelvic exams, long labours, actual deliveries, cuttings of cords, placenta delivery etc.  It was amazing to watch really, and exciting every time once the baby was born.  There was one complication through the night, being a long labour from an 18 year old, her first baby.  Took her 20 or so minutes to push the baby out and then after all that the baby wasn't breathing :(  I felt so bad, but the nurses worked on him straight away:  hanging him upside down and rubbing his back, to stimulate his lungs.  Also did this crunch looking thing with the baby like you would an accordion, put him on oxygen and after a while he started breathing on his own! I was so happy when he took his breath because I just thought, this mother didn't go through all of this pain for nothing.  I had held her hand throughout the delivery and gave her a thumbs up sign when he started breathing and she did one back with a smile. It was really nice.  Didn't get really slow until about 4am where there was no more births, a few admissions I entered into the books, so I got to read and drink really sugary black tea that the nurses had in the 'staff room'

Taking the patient to have a C-Section

The beds that the patients give birth on and examined.

The tables to hold the babies until Mum is ready

Tuesday night:  Me + 2 other volunteers.  4 births and one C-section.  The C-section was the first part of the night, had to wheel her on a stretcher from maternity to major theatre over REALLY bumpy and rocky pavement. They cut her open and a bit of dark dark red pieces were coming out of the uterus...not good apparently, after the baby was born not breathing and completely lifeless and the nurses didn't seem to care or do anything, I had to ask what was going on.  Turns out that the placenta had ruptured at the start of contractions, the woman had had a previous c-section and it could have left the uterus weak?  I asked if she'd be able to have any more children and the doctor said that the chances of this happening again were really high, that she was considering suggesting to the mum to have her tubes tied.  Since she only has had one child, this is probably not going to happen.  Another volunteer, Chloe, and I suggested that for the next pregnancy, just do a C-section before the contractions start! Take the baby out a few weeks early, and the doctor paused to think and said:  "That's a good idea, I didn't think about that.  I will suggest it to the mother" and then proceeded to tell us that the only negative thing with that is that the ultrasound at this hospital is really crap and they can't tell how old the fetus is and often the mothers don't have any idea either.  It's a real shame...
      The other births were straight forward and I got to do a pelvic exam! At first I had no idea what I was supposed to be feeling for but then I found the cervix! yay.  I weighed the babies, most were around 3.2-3.8kg,  and made sure they were put under the heat lamp to stay warm even though they were wrapped in so many layers of Kangas (the colourful garment that you would typically see in African photos) and got to listen to heart beats before the baby was born using a metal tube like thing with indentations on either side, small for the ear and large for the belly.

Questions/Observations:
       1)  Glucose in a syringe is fed to the infants if the mother's milk isn't flowing or the baby can't seem to latch on to the nipple...What do we give to the babies in this situation?
       2) No Epidural or any drug is give to the mothers during labour or delivery. (only Oxytocin injections to ease the placenta out) The moms hardly shout or make any kind of noises, a few mutterings and heavy breathing but otherwise quiet.  NOT what you see on tv of birthing shows.  These women are tough!
        3)  Mother's before and after birth share beds in the two rooms as there are not enough for everyone.  It's actually really great to see the mom's all helping each other out and being really caring, like it's one large family.
     **4)  Many women were circumcised I noticed.  Either the clitoris was removed, or the labia, or in some cases both.  It depended on what tribe she was part of, really sad.  Apparently a lot of these rituals cause the mom to tear during labour (which I saw two tears lastnight) because the vagina healed very tightly.
        5)  The generator at the hospital doesn't always come back on straight away, it did really quick on Monday night and then took about 5 or so minutes to come back on the second night.  It happened whilst the doctors were suturing up the women who had the C-section, the worst part was that they were trying to go quickly because she was waking up!! and we had to rely on using torch lights and ipod/iphone/mobile phone torches too! insane.
      6) There is a resident rat living in the maternity ward that just runs around sometimes...and cockroaches. Reason why we had to keep our bags on chairs or on the desk in the staff room. Lovely.

 Really liked the night shift :D definitely going to do it again!  Next week is my last week though...I'm very sad about that, I'm starting to really get used to everything and don't want to leave.

OBAMALand

Boxers with Obama

Tanzanian man:  "Where are you from?"

Me:  "I'm from America"

Tanzanian man:  "The USA?! Obamaland!"

Typical reaction to the question of where am I from.  Or:

"Do you have any good ideas for change?"
"Obama represents Kenya, do you like Obama?" ....

11th June-Masaii village

I visited a Masaii Village today with my room mate, Chloe, another volunteer at the hospital who did one month at the orphanage and then her final month at Tengeru with me.  We didn't actually go to the village in the bush, a typical Masaii village like what we saw during the safari but instead we saw the kind that have integrated into the community and wear western clothes. It was really cool/unfortunate to see how they live, more like the poorer villages that I imagined Africa to be like and it's just kind of amazing that they can live their whole lives in places like they do and then you think of all that we have.  Their houses are made of wood with mud or dung walls that have to be re-plastered every few months, no floors-just dirt, one bed for multiple children, a kitchen that consists of a fire pit and few pots and pans. 

The typical housing unit.

Kitchen house

Typical kitchen with rice boiling

Coming out of the hut with the double bed (which is a modern convenience)

Main living house, made of dung.

Double bed for the children...there were about 5 of them.

The farm animals are right next to the house, and they have a garden that looked like it had banana, mango and/or avocado trees, this one house did at least.  Before that we went to a traditional Masaii market, one that is ONLY for people in the Masaii tribe both Warusha Masaii and traditional...and ofcourse Mzungos [white people] with tour guides.  There was were they all gather to sell/trade goats, cows, donkeys etc.  It was so crowded! We even had to have another guide to speak Masaii because Swahili wasn't spoken there, or hardly, which made it more fun!

In those 'houses' are the women making tea and beans/rice

Not a clue what he was saying, but he was all smiley and very animated!

One of the Masaii men who spoke english asked Chloe if she was married, she said no, and he told her to take the young man standing next to her! Thought it nice of him to allow her to choose rather than the opposite way around ;)   She said she was too young, she had too many things she'd like to do.  He said, she is old, most Masaii girls marry at 16 or less. He just gave me his goat herding stick because I had a ring on my right hand ring finger, so most people assume that I am engaged and I just go with it...

Very good day! Enjoyed seeing more of the local culture and it was interesting to realise that I have been living in a relatively affluent part of town...and even that is saying a lot! We take SO MUCH for granted back home (UK and US).

10th June- Full Day in Lab

Worked in the lab today doing ALL of the patient blood testing, draws and pricks for the various tests.  I'm getting so much better at the blood pricking for the rapid tests.  It's not as easy as it looks to get the blood drop into the center of the loop below

I've found, however, the bigger people are harder to get veins for and older people have veins that move around a lot if they are thin and their elasticity has gone more so than others.  But now I really understand what my mom meant when she always mentioned that veins would be good to 'poke' :)  haha whenever I see good ones I would love to just draw the blood cause they'd be so easy!  This day though we were really busy...it was just me, one other volunteer, Chelsey from Michigan, and a Tanzanian technician named Happiness.  I don't know what they would have done had we NOT been there. 

Matt and I performing Widal tests

Me doing an erythrocyte sedimentation rate test

Happiness is always telling me that she wants an American husband, that when I go back to the States to look for a husband for her.  The male doctors do that as well, asking if we (being white EU or Amer. female volunteers) want to marry them or get a Tanzanian boyfriend and settle there.  I really don't know what it is with everyone wanting to get married so young! and they find it weird when we say that we are too young.  A lot of people here seem to get married quite young, especially if they are part of a local tribe, Meru or Masaii.  Many of the young girls have already had one or two children by my age!  Very different, but it's their culture.

Gonna do the night shift on Monday and Tuesday (didn't end up going the other night), it's going on the weekend now so I have to wait til then.  Should be good, I just hope I can stay 100% all night.

9th June--OPD

     Spent the day in OPD, out patients department.  Happened to be put in a consulting room with one of the head doctors and he was excellent! Such a good teacher, that I actually felt like I learned a lot from him as he took the time to explain things as we went.  Whenever I had questions he even took time away from the patient after speaking a slew of swahili to make sure that I understood in english, didn't mean for him to but it was the idea that he wanted me to be included as he proceeds that was really nice.  [Dr. Mburi]
    Saw two older women come in with a prolapsed uterus, of which I hadn't really heard much less seen before now.  He told me that it happens a lot in older women as the muscles lose elasticity as we age that they no longer hold the uterus in place, therefore it just comes out of the vagina.  Another reason that could cause this to happen is if a women has had many births in her lifetime that as she ages, the muscles are just so weak.  The first women had had 7 children and the second had 9 in her life.  Temporary solution to the problem: shove it back until a more permanent solution can take place-->that being surgery to either 1) remove the uterus entirely or 2) cut part of the muscle that holds it in place so that it is shorter when it heals.

     One thing that the doctor pointed out to me was that not all patients say what their immediate symptoms or issues are out of embarrassment and not all doctors will find out the problem if they don't do a thorough analysis and exam.  The second women for instance, went on and on about pain that she has and how all the medication that other doctors have prescribed to her hadn't worked, she was talking so much, to me, telling the doctor her whole life story (it was in swahili) and finally Dr. Mburi did an exam on her and immediately found her problem, that she neglected to mention.  That's why he stressed that as a doctor you must always do an exam during each consult if the problem isn't obvious.

    One of the other patients that stood out to me was a young guy with a hugely swollen right leg with no open wound.  The doctor pressed on his leg and it left an indentation, which I had never seen before and he told me that it means that fluid is outside cells, pitting edema.  Dr. Mburi had me feel the leg to see if it was warm or cold, warm usually meaning that there is an infection within. Because there was no history of organ problems within his family and he was a relatively healthy guy, the doctor determined that it had to be a bacterial infection {from only one leg being swollen and it being warm to the touch} and prescribed him wide-range antibiotics. 

    It was a really good morning, was in there in OPD from 8ish to 3 then took the dallah-dallah home.  Had a bucket shower, power was out which I haven't really described yet.  Well, power goes out everyday at any time of the day and for a who knows amount of time.  The power company decided to ration the electricity around the country in February and they just didn't stop I guess after having a nationwide deficit on the grid.  You get used to it, using gas for cooking and many candles, lanterns and torches.  Anyways, went to the market with mama Beatrice to buy vegetables for dinner, so many sellers in the Usa Market of the same things though: oranges, tomatoes, potatoes, sweet potatoes, carrots, greens, avocados, and eggplant (aubergine), bananas, passion fruit, beans and spices.  That's about it for fruit and veg, then you have all the clothes and shoes and bags like in the Arusha market.  Ridiculously cheap though! Beatrice filled two plastic bags with 10 oranges 10-12 whole carrots, a bunch of greens, 6 ginormous sweet potatoes, and about 10+ tomatoes for only 12000Tsh....about £5 or $7...if only :( 

      Ella and I decided to surprise the family and make banana fritters for desert.  We had so many bananas just sitting in the kitchen getting mushy and black that we could stand for them to be chucked out! It was my first time making/eating them and it was so simple!  Bananas, flour and spices!! Put a little bit of oil in the pan, shove a banana slice on one side and fry away until firm and that's it! They tasted sooo good too :)  Had to cook by head torch light and lantern, but was fun that way.  One thing that was interesting though was how often Line and Lily, the daughters, kept asking if we wanted to put more oil in the pan, which we didn't need to.  They, being most Tanzanians that I have met, don't seem to realise that you DON'T need to add a cup of oil to EVERYTHING that they cook.  Don't get me wrong, all their food is great and I look forward to it all but also it can be very oily. 

Banana Fritters!

8th June- Bananas roasted with Galaxy!

Asked about doing night shifts next week, seeing as during the mornings there are quite a few volunteers about (around 15) so each ward is getting pretty crowded and there is less involvement when there are so many of us.  Night shifts are good because there are supposedly only a couple volunteers.  Looking forward to it!

Was in the lab again today, I'm really liking it in there because I really feel like I'm doing something to help rather than just stand around and observe.  Today was actually kind of a quiet day though, not many patients, which I know is a GOOD thing! but it just makes you wonder if you are really using your time wisely.  Did do several Widal tests (testing for typhoid), malaria and an HIV test...which I found out can not be said aloud as an HIV test for confidentiality reasons and is called something else which I can never remember.  Unfortunately this sample today was positive after running the rapid HIV test and then another stick test that takes 20 minutes to set...shame :(  Also managed to do several blood draws today and hit the veins everytime! (touch wood for next time)

Lily, me and another medical volunteer (Alan)

The kids with roasted choc. bananas and a Hobnob biscuit.

Went to the orphanage again today.  The group of us planned to do a bonfire with the kids and roast marshmallows and I said I'd introduce them, and I guess everyone else to s'mores!  Took our family's daughter Lily with us for the evening.  It was really fun!! Didn't end up making s'mores after all because one of the other volunteers had already prepared a bunch of bananas with galaxy chocolate pieces in them to be roasted on the fire...pretty clever!! I've never heard of such a thing, but they ended up tasting delicious!  The kids seemed to really enjoy themselves and all the sweets, I feel bad for the mamas, hopefully the kids will 1) go to sleep at a decent hour after eating so much sugar that they don't usually do and 2) the kids won't be sick from the sweets. 

After a few hours we eventually went home to get dinner of coconut milk beans and rice and watermelon!! yay :D  Good food, see the food section for a look. Then bed time, pretty exhausted.

7th June- First day in the Lab

Went on a 3-day safari to the Serengeti and Ngorongoro Crater.  AWESOME, had promised myself I'd do that since I was 7 and watching Animal Planet Documentaries.  Such a good weekend and well worth it.

Drew blood today in the laboratory for the first time!! Happened to get a patient with really hydrated veins, nice and juicy with blood that it was pretty much popping out.  But I did others that weren't as good and it was really cool to be involved with taking tests!  I also learned how to perform the blood testing:

Malaria rapid test, negative result.

     Malaria: pinprick, drop of blood for the rapid test...one solid line means negative
     Widal Test: testing for salmonella.  Take the blood sample, centrifuge it, put one drop  of serum in two circles and then add typhoid antigen 'O' into one circle and antigen 'H'  into the other.  Stir and swirl for a minute to see if there is a reaction.  Reaction means positive and would look really grainy versus just a smooth colour change.  Rinse and reuse the test papers twice...dunno how sanitary that is??
     Full Blood Picture: machine tells you all the number you need.

Lab to the left, out-patients in the centre and major theatre on the right.

One of the things lacking in this lab is 1) GLOVES, the technicians only change gloves if they are dealing with pee or poop, I am pretty sure at least they change then, or if they get blood on their gloves.  If not, they are good for three or four patients!  Had to get used to that.  It's because they don't always have disposable gloves around so they ration when they can.  Also there was only on tourniquet for patients so the waiting room was packed and we could only do one test at a time, even if it was just a quick prick...one patient at a time. 

Oh yeah....on the aside, Chelsey and I decided to figure out what blood type we are! I really like blood grouping, though everyone seems to be either O+ or A+ (makes sense) and getting B's are exciting because they are rare, and especially ABs which I only got once out of the MANY tests that I did.  I am A+ and Chelsey is O-...hardly got negatives also.  A couple other volunteers want to know their blood type too, so tomorrow we'll do theirs.

1st June-What a way to help out!?

Helped with an abortion or evacuation today in minor theatre.  When I saw helped, I held a metal clamp that held the vagina open so the doctor had one more free hand to do what he needed to do.  The doctor just scraped away the placenta or whatever was around there in the uterus that came out in bloody clumps into the bin below, meanwhile warmly passing over my hand as it slid down....The poor woman though, there were two, the procedure looked sooo painful!! It's a great thing to watch to preach abstinence or birth control! but also some women need to be cleaned from scars and such as well to help in getting pregnant.  The smell was horrible, I'm gonna just throw that out there.

Also did ward rounds with the majority of the doctors in the morning (takes place every Wednesday) where they discuss the severe or interesting cases.  Mainly takes place in the paediatric unit or maternity ward.
     1) Burnt baby-arm and face-some skin peeled off and a lot of swelling.  He had very little ointment on him and no gauze covering the exposed dermis and no mosquito net open to prevent flies and bacteria they can carry. What got me with this is that while the doctor was talking about him he even mentioned that he'd prefer all his patients to have mosquito nets around them to prevent flies but this child didn't have one at all! and what's more...the mosquito net was just tied up above  EVERY bed, just NONE of them were open! mind boggling :(  The doctor also said that the majority of their patients will get a bacterial infection because of the hospital...atleast he doesn't lie to himself, it's kind of frustrating to hear/see.
     2)Saw severe pneumonia child, which I found out are quite common here
     3) Saw malaria child turned blind after being on quinine (an anti-malarial medication) for a week.  Doctors weren't sure at first if it was the malaria that perhaps had caused some brain damage but then the matron mentioned a friend of hers that had malaria and took quinine and became deaf and blind for two years and then her senses came back.  These are possible rare side effects unfortunately, but sometimes it comes back when the treatment is stopped. Hopefully this will happen to the child as well.
  

FOOD

Uji

Breakfast porridge, uji, is popular...but to all you porridge/oatmeal fans (ME) it is NOT what you are thinking.  For one it isn't even made of oats and it's really running and you MUST eat it with sugar otherwise it tastes of nothing.
Ingredients:
Maize flour, millet, salt and my host mum crushed peanuts into it, and then you just boil it until it's at the right consistancy--runny--but you have to make sure you boil the water fully to kill any parasites.  It's edible but I limited the amount I ate because I didn't really like it.

weird potato on the left and sweet potato on the right.

Sweet Potato!!  so so good.  Different from home, purple outside and white inside but so sweet and flavourful! don't need anything to go with it and it's delicious.  It's a great breakfast food too, I actually came to really look forward to when sweet potatoes were cooked :)

 

Maandazi

 Maandazi:  Like doughnuts, fried balls of dough with a lot of sugar in the recipe...really good with tea!

Ugali

    Ugali:  Doesn't taste like anything....just a ball of firm dough it seems like that you eat with your hands, I have to cover it with something else that I am eating with dinner to eat it...not a fan but it's a traditional Tanzanian favourite!  It's made with maize flour and water and boiled to a dough like consistency and tah-dah! you have ugali.

Ella and an avocado the size of a small watermelon!

Line and an avocado!

   Avocado:  HUMONGOUS!! I'm not kidding, they are huge, the size of Line's head in the above picture.  About 10 wedges in one avocado...and Tanzanians love them.  They generally have them with lunch and dinner, it's in their juices and my host dad eats one half for himself and splits the other half with the rest of us at dinner (5 other people).  Was shocked when I first saw them, didn't know what they were!

Mama Beatrice cooking away on the charcoal grill!

 Coconut Beans {Maharagwe} w/Rice:   So so good!! One of my favourite meals that Beatrice cooked.  Beans fro the market, sorted through outside on a large round flat weaved..thing..to get all the crappy beans or ones that are deformed.  Then rinsed twice, and it's amazing how dirty they really are! Then boiled for however long it takes for them to be ready, about 30-45 minutes? Then Mama Beatrice scrapes the inside of the coconut on a traditional coconut scraper thing? to get the fruit and then she squeezes the juice out of it to put in the beans, and then adds carrots, peppers and onions and that's it! mmmm

Typical dinner time--nomnomnom

 Juice--made with one half avocado, one mango, two/three bananas and a passion fruit if we have one and then water added.  It is just like a smoothie and tastes delicious!  Didn't have it every night, so when we did it was a treat...about every three or so meals we'd have it with dinner.  Sometimes she'd add a bit of ginger to it too, that was lovely.

Roasted Maize

 Roasted Maize:  Found at any market or along the streets.  Women roast large sacks full of maize and sell them for 200 Tsh and they are a tasty snack.  HOWEVER, don't be fooled by their appearance to sweet corn on the cob because they taste nothing like corn on the cob.  Instead they just taste like popcorn.  Maize has a harder consistency than sweet corn and it is not as sweet, but like I said, it makes a good snack.  Maize flour is also a common ingredient in a lot of dishes.

 Greenish Oranges:  Oranges are always found at markets, and stacked in groups of five and sold for 500Tsh.  When I first arrived in late May, the oranges were still green but surprisingly edible and not too sour.  Over the course of the month, they started to become a bit yellower in colour and slightly sweeter! It was an exciting process to witness, but definitely makes you appreciate the super sweet super bright orange oranges back home!  And the Tanzanians eat them very oddly.  They peel the skin, but just the hard layer off of the entire orange, cut it in half and then eat the inside, though I think they mainly just suck the juice...basically they aren't eating the whole orange.  I tried to teach our host dad, Joshua, how it's so much easier cutting the orange in quarters and then peeling the entire orange piece off that way, but I guess old habits die hard.

Sukuma wiki with ugali and chicken

Collared Greens or Kale {Sukuma wiki}:  literally meaning 'to push the week'  it is another one of my favourite vegetable dishes that Mama Beatrice made many times.  All it is is boiled kale, spinach, greens, pumpkin leaves, sweet potato leaves, etc. and oil, tomatoes, salt and Beatrice liked to add onion and chopped carrots as well. Tasty...this makes the Ugali edible for me!

Ndizi na Nyama with coconut milk

Same thing without coconut milk.

Plantains with Meat {Ndizi na Nyama}: Had this dish twice, once at home with coconut milk and once at a pub without coconut milk.  Both were good, and I think I preferred the one without the milk in it because I could taste the other flavours more.  It is made with cooking bananas (plantains), potatoes, and whatever meat you have on hand, I've had it once with beef and the other time with chicken.  It is a typical East African dish :)