Summer Vacation

It seems that children love summer vacation as much in Africa as they do back in North America. They were so excited they were awake even earlier than usual for their first day of vacation. The school year here runs with the calendar year, so the kids had their last day of school this past Friday, complete with an awards ceremony and singing. And, man, can these kids sing. It’s beautiful.

Here’s a question for you: How in the world do parents juggle work and kids and life? We (Dr. Frank, myself, and some volunteer doctors) have been doing health screenings these 2 weeks for the children in standards 1-6 at two local schools, about 1000 children in total. After getting the kids up and ready for breakfast, a group of us head off to clinic, then home in time for bath, dinner, and bedtime. Whew. I find that our kids get just what is left of me at the end of the day. Is this how working parents feel? Except that I don’t even have to cook or clean OR pay bills!

So, once again, I find myself reminded of how lucky I am. Thanks, Mom, for doing it for years on your own. And thanks, Dad, for coming along and helping her out. Kudos to those of you who continue to juggle it all! I understand better why some parents like their kids to be in school! =)

For restoration, I try to steal away for a few quiet minutes at some point during the day. There’s always the option of simply hiding in the coffee fields—which, mind you, is especially wonderful right now as the coffee trees are in bloom with white flowers, and it’s similar to the smell of jasmine floating through the air. It’s like an African White Christmas.

Speaking of holidays, we had a memorable Thanksgiving dinner this past Saturday at Mama India’s house, thanks to our Tanzanian staff who did their best to give us an American feast. We had the only turkey in Tanzania, probably East Africa, or maybe even the whole continent. It was complete with stuffing, cranberry sauce brought over in a duffel that came with a recent volunteer, and pie as close as possible without an oven that works properly. We enjoyed it immensely!

To make the evening complete, I was on nurse duty with one of our kids who had meningitis (our best guess with no lab tests). He was on 5 days of IV antibiotics. When he got sick, we luckily had two volunteer doctors here to help with our clinics, and it was a wonderful 3:1 ratio! It was African medicine at its best, with the IV bag hanging from the handle of a spoon shoved under the mattress of the top bunk bed.

So I have one more week here at the orphanage before I head out to do some traveling around Tanzania. Time has flown, but I will be sure to make the most of it these next few days of summer vacation!

Happy Thanksgiving

It’s that time of year again for pumpkin pie, turkey, cranberry sauce, mashed potatoes, Mom’s awesome yam casserole and biscuits, and so many more of my favorite foods. Oh, yes, and it’s the time to be thankful.

As I have mentioned before, this place has shown me over and over again how lucky I really am. We have all those things I have taken for granted…those basic things needed for survival that so many here do not have…Water. Food. Shelter. Clothing. Health. And those priceless gifts…Family. Friends. Fellowship. Love.

Words are insufficient, or I’m not eloquent enough, to express how thankful I am for all of these and I hope I always remember how lucky I am. There are a few other things for which I am extremely grateful, especially since being in Africa.

1. Hot showers. I’ve had a handful over the past month, and they were true luxury.

2. Freedom. Oppression still does exist, especially for women and children, in this world of poverty, genocide, female circumcision, child labor, child prostitution. I am so lucky to be a female born into the land of privilege and justice, home of the free and brave.

3. Guardian Angels. It was an eventful night in the big city of Arusha where I had gone last weekend, and met up with two other volunteers. It was dark, so we hopped into a taxi to grab dinner across town. Now, there are cement trenches, about 5 feet deep and same across on each side of the main roads (for water in rainy season?). The taxi driver went off the road and we landed sideways in it, snugly tucked down in, the car smack on its left side. We scrambled out to safety, gratefully unscathed. I may be sending my guardian angels into early retirement, but I’m so thankful they are working hard now!

4. The native staff who are the Mamas/drivers/escaris (guards)/market-goers/solar power fixers/creepy-crawly killers/everything else we need them to be. They look after us like we are family, and I feel completely safe in their watch.

5. Toilets that flush. Toilet PAPER for that matter.

Happy Thanksgiving to everyone. Enjoy this wonderful holiday, eat lots for me and others here, and be thankful!

A Nurse's Work is Never Done

There is no such thing as a 12 hour shift or regular working hours around here. Duty calls all times of day…in the middle of class, during meals, and (my favorite) just after I’ve settled into bed. Sometimes they are even sick! =) It’s good to be useful though.

This past Sunday is a great example. It is the one day of the week when volunteers are off duty. I was leaving the Volunteer House after breakfast to find Paolo, 7, sitting outside crying. He lifted up his shirt to show me some fresh scrapes on his belly from a fall. Now, he knew not to come inside but was patiently hanging around until I appeared. Smart little guy, he knows I won’t turn him away. As most of them do, it seems. Bugger, didn’t know I was so transparent! We ceremoniously cleaned and applied bandaids, and he proudly showed me his healed boo-boos the next day.

We currently have mumps spreading around the children, and each morning there seems to be another waking up with a swollen neck. I’m a little relieved to have missed the chicken pox outbreak this summer. The one thing children are great at sharing is all their bugs!

My toughest patient has been on-going, a lady from a nearby village who came in late one night with second and third degree burns covering her arm and face. She had tripped and spilled hot porridge on herself. Thankfully Dr. Frank was here for the weekend clinic! She says she’s 60 years old, but looks every day of 95; she’s tiny, tough, and completely endearing. She lives the next village over, so we asked her to come back every other day (instead of every day) for dressing changes, but she no-showed, and we sent out a search party…it was 4 days before she came back. With burns, that’s a looong time. Oh boy, oh boy, oh boy, I was NOT prepared for what I saw…between the smell, the pus, and the collection of charred skin…

It was nearly 2 hours of painstaking work, painful for her, and it was just the beginning. Despite giving her as much Tylenol and Motrin as one liver should have, I could not make her comfortable. No surprise. She cussed me out in Swahili (or at least scolded me) and practically levitated from pain, but stuck it out. Like I said, she is TOUGH. After two consecutive days, I could still not get it under control; it was just too far gone to clean well with my equipment, and I was in tears (again—goodness!) for her pain and my frustration on not being able to help her like I wanted. With the dirt, dust, and poor living conditions, it is nearly impossible to keep a wound clean and infection-free. This is where my Western medicine training got the best of me again…I know how it could be done, but did not have the means to do it, and it was my mental roadblock. Mama India gave me perspective in that she has seen worse here, and the man survived.

Nonetheless, Dr. Frank obliged to bring some GOOD drugs from his clinic to make her comfortable so we could get her scrubbed properly. Now, this is a great doctor for you—despite being sick himself, Dr. Frank agreed to make the hour drive with an IV cocktail for the following day’s visit. It was redeeming when she made sure I would be there, not just the doctor, for the following day.

So today was quite the experience with my little lady. Dr. Frank was a beautiful sight as he brought his magic meds for our burn scrub. I understood his dilemma in not having exactly what he wanted either for her sedation, but it was better than nothing. It was a little rough going down and coming out, but she did well. We accomplished what we needed, got her fixed up for today, and sent her home with some food and medicine to survive until we meet again.

Tomorrow is another day with new challenges, but today we did what we came to do. All in a day’s work.

Thursday 15 Nov

Days Off

It has been nearly 4 weeks here in Tanzania, and time for my allotted days off…

So, I was off to Lake Manyara with 3 other volunteers last week. It is only about an hour from here once you hit the main road, so it was an easy day safari. We headed out at 7am to catch the morning wildlife, and the animals were so obliging! We saw giraffes (one of my favorite), water buffalo, impalas, hippopotamus (love that word), elephants (another favorite), wild hogs, baboons (gotta love them!), flamingos, zebras, wildebeest, and even a cheetah!

We had pulled over to watch an elephant at a watering hole just a few yards away, as it hosed itself down with its amazingly dexterious long nose. Our guide pointed to a group of low trees on the other side of the road, saying there was a cheetah under them. We couldn’t see a thing, so turned our attention back to the elephant. After her bath, she ambled over to us, looked as if she would walk right over us, then detoured to go in front of the LandRover. She then headed straight to the group of trees with the alleged cheetah, and flushed the cheetah out! Before I could blink three times, and definitely before I could grab my camera, it was gone. SO fun to see all these amazing creatures in their true environment.

The following day, I got to meet up with 2 missionaries from my faith in Karatu, our closest town. It was the best 24 hours I have had here, seeing familiar faces and sharing wonderful conversations. It has been an adventure being here alone, and has made me appreciate even more the moments I have with family and friends.

This weekend, some locals took a couple of us across to the Ngorongoro Conservation Area, illegally of course, to a beautiful but secret waterfall. For part of it, we followed a trail made by the elephants, but the last quarter mile was true trail blazing. Guess the elephants aren’t into waterfalls. It was gorgeous with a small pool at the base, and a few were brave enough to jump into it. I’ve seen enough funky diseases and rashes to squelch a little of my adventurous side! =)

Thank you again for everyone’s emails. I AM trying to get back to everyone. Hope all is well back home!

Hug!

Thank you, thank you, thank you so much for your emails and comments. Asante sana sana. It means so much and helps ALOT. As one volunteer said—A bad day here is so much worse than a bad day at home. On the same token, a good moment here is even more amazing than many good days at home.

Yesterday, I had such a moment. Myself and another volunteer didn’t have bathtime duty so we went for a walk on one of the many trails through the coffee fields. Just as we were passing the local primary school, the kids came flooding out to head home. In a matter of seconds, we were surrounded by nearly 30 kids crying “Hug, Hug!!”

What a great gift—easy to dispense, free, and a limitless supply. These children see our kids here at the orphanage getting plenty of hugs and attention, and here was their chance to get some too. We made it through all of them, some coming back for seconds, others giggling and jumping up and down in their excitement. Definitely a great moment.

Thank you again for your support from home. I am so happy to have it! Hugs to all!

Doctor Amber, Part II

Wednesday: Day of Acceptance

I could not fix everyone, but I can do what I can, in this small part of the world. Dr. Frank helped me to reframe. Maybe they will be sick again in one month, but we can help them in this moment. And if that is what I can do, then that is what I will do. No one left me empty-handed. Multivitamins for everyone, even if it is just a week’s worth. We have to start somewhere.

It is simply amazing to me that anyone survives at all. No clean water, if there is water at all. Not enough food. Always dirty. I can never complain again.

Our 84 year-old man was back for more Tums.

Dr. Frank has an entourage, I must tell you about. Carlos (photographer) and Meredith (reporter) are with the San Francisco Chronicle, and are doing a story and documentary on FAME (Foundation for African Medicine and Education—Dr. Frank’s organization). They are cool cats, and have captured so well what we have experienced. For my Bay Area friends, keep your eye out! They plan to run the story in December. (Save one for me!)

Thursday: Day at the Boma

We left Minjingu and went off the beaten track again to a boma, or little accumulation of huts out in the bush. These were pure tribal people, some had never seen white people it seemed. This village was all women and children as the men are off working in the tanzanite mines for months. I have never seen such a sick group of people. The infections and malnourishment was overwhelming. And I thought I had seen sickness. EVERYONE was sick, and many very sick. TB, malaria, HIV, everything from the past few days plus more.

I had seen plenty of scars by this point from works of witch doctors, but today I saw a fresh wound that was most disturbing. She was 3 years old and so trusting of me, as I slightly moved her cloth to listen to her lungs. Peeking out at me was some dirty gauze and tape, who knows how long it had been there. She leaned into me and never flinched as I began taking it off. It was almost disturbing that she was so trusting, It was as if she was used to being man-handled. Even I almost lost my stomach. Pus oozed from a wound on her rib cage. After I cleaned it away, I found a circular abscess as if a chunk of her had been cut away. If I had seen the witch doctor, he would have seen the witch come out of me. How could you do such a thing to a child?? I understand there are major cultural differences here, and in their minds they are helping, but to me there is a huge line being crossed when children are being hurt this way.

Once again, we do what we can…one person at a time, right?

Doctor Amber, Part I

Medical school, sch-medical school. I got promoted from RN to MD by Dr. Frank, after a 10-minute crash course on tropical medicine. With 300 children to see, and only myself, Dr. Frank, and Dr. Stella from Arusha, we had to pool our resources. Thank goodness for 9 years of experience, and the wonderful physicians I have worked with over the years who have taught me well. Thank goodness as well for Dr. Frank’s patience. African medicine is medicine in its simplest, yet most-honed (is that a word?) form. There are no labs, no x-rays, no diagnostic tests. You have your patient and your intuition. As for meds, you have what is available, what was donated, what was cheapest, what the government will allow. It is not ideal medicine, but it IS the only medicine some will ever receive.

There was a group of 8 of us, including other volunteers and Susan, Frank’s wife. We headed out Sunday afternoon to a little village about 3 hours from here. We were met there by Paula, an American and Occupational Therapist, who has an organization to spy out different needs and arrange for services. We stayed at the “Guest House” in the village, which is usually occupied by prostitutes when not filled with mzungus (white people) such as ourselves. This place made camping look like the Ritz Carlton, and the orphanage seem glamorous. The toilets were holes in the ground, and we had dirty buckets of questionably clean water with which to bathe. I didn’t pee or poo for 5 days. We all have come back with suspicious bites all over out bodies, which I am guessing to be bedbugs. We ate the native ugali (maize type grain), goat meat, and bananas. It was a taste of life as many know it here. Aahh, the price of adventure.

Monday: Day of Hope and Anticipation

We headed out for the first of three days to do wellness checks on approx 300 children at the local school. On our 40 minute ride down a “road” equivalent to driving over cement blocks, six giraffes amble across the road in front of us! Such elegant creatures. Then another 10 minutes off-roading to the school. By the time we arrived my bones were in a different anatomic order. Fungus, worms, and malnutrition were prevalent. Throw in the occasional bug in the ear, wound abscess, malaria, and welcome to African medicine. We powered through about 100 children, while Dr. Frank saw the local adults who filtered in to see the white doctor. Our much needed comic relief came in the form of a 84 year-old man complaining that he was only able to “be with his wife” three times a day instead of his usual 9. We appeased him with some Tums. We had a focal group of seizure patients, most with epilepsy due to cerebral malaria. It didn’t take long for me to recognize the glassy look of malaria versus the gray look of worms. How do they even survive?

Tuesday: Day I Cried

It was overwhelming. The day started off well enough, with a young lady with a snake bite on her foot swollen twice the size, After lancing it, (skip ahead if you are faint of heart) pus came pouring out, and I wonder how she managed to walk for 2 weeks on it. I met an 8 year-old girl with a broken elbow that was casted wrong at the hospital, so it “healed” at an odd angle, and would never have full use of her arm. The family did what they could to get help…Life is not fair. She already has odds stacked against her.

Monday I had managed to be resilient as child after child came through with complaints of stomachache. Ask them what they had to eat that day, and they hadn’t….even at 3pm in the afternoon. Every single child. I don’t know what it particularly was about this one 10 year old boy, but he was my breaking point. He had the usual complaint of stomachache from hunger, but also had a cough at night. I asked if he was cold at night. Always cold. Asked if he had a blanket at night. No blanket. Asked if he had more clothes to put on. No more clothes. And he answered with his head hung down, as if he was ashamed. Not asking for more. He was simply being honest. His humility was heartbreaking. The futility of what I was doing just overcame me. How could we even put a dent in this poverty and sickness?
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