Welcome to 2014 and new adventures

Welcome to 2014  and to all my family, friends, colleagues and whoever is reading my blog -

Well, for me 2014 started out on the beautiful island of Madagascar in the small beach village of Morondova, across from Mozambique on the west coast of the island.  Madagascar is the 4th largest island in the world and truly is large - the quickest way to get around is to fly.  After arriving in Anatanarivo (everyone calls it Tana), the largest city and capital, my colleague, Cathleen and I were met by our guide, Hari.  We spent the first night in a lovely hotel, and then started the next morning to drive over the next two days to Morondova, on the west coast of the island.  Antanarivo is located in the center of the island and has a total of 12 hills in the city.  Most of the streets are cobblestone.   It reminded me a little of Venice without water, but with hills, some very steep.  The people in Tana have a Malaysian appearance - and are very friendly.  Since Madagascar was at one time a French colony, French is still a common language, along with Madagasy.  There are baquettes everywhere and many restaurants with good French food and wine.

  Our first stop was a small city about two hours south of Tana, Antsirabe, where we spent the night and toured some small "mom and pop" businesses.  I found the Madagasy people very hospitable and industrious.  These small businesses were making paper, recycling aluminum into cooking pots, making jewelry and other items from "zebu (cow/oxen) horns", and making candy.

Paper Making Factory

Zebu Horn Carving Factory

Aluminum Recycling Business

Candy Making Family Business

The following day, we spent the next 10 hours driving from Antsirabe to Morondova on the west coast.  This was a great opportunity to see the countryside and notice the change in people and living from the center of the island to the west coast.  The west coast has a strong African influence both in appearance of the people and in their houses.

Countryside 

You could not visit Madagascar without seeing the Baobab Trees. -  We were fortunate to visit at sunset and get some great photos.

The mode of transportation in many parts is still the cart with "zebu's" or a "rickshaw" type vehicle either pulled by human energy (foot power) or by a bicycle. 

The ocean was beautiful, although too warm for my liking and the sunsets spectacular.

 After spending 3 days in Morondova, where we visited the Kirindy Dry Forest, we then flew back to Tana.  You could not have a visit to Madagascar without seeing lemur's.  We went to a lemur park in Tana where you could walk freely among them.  We had a wonderful guide who was very enthusiastic and informative and told us about 9 different species in this park.  

This was a wonderful opportunity to see a most amazing country.  I am sure one I will most likely not be able to repeat.  

Since returning to Mwanza after my nice break,  I went back to full working mode with lecturing and clinical supervision.   On some days I will have about 50+ students on the clinical wards, spread out over 7 areas.  Some are on a ward for one week and some for two weeks.  I try to get by to see each student to have them present their patient and the nursing care they are giving.  

Slowly, I am working with the charge nurses on each ward to have them begin to pass on some of their "pearls" to the students.   There are so many "needs" and it is difficult to identify which ones are the most important.  Everyday and sometimes more than once a day, I need to "recalibrate" my thinking as to what is the highest priority as well as to why I am here.  It is always a challenge, but if you look at the glass half full - you are not disappointed.  There have been many articles written about working as either a doctor or nurse in a developing country - and the normal stages you go through - sort of like Kubler Ross's Stages and I have to say that I have experienced almost all of them.  In order to make effective change you first have to be able to identify what you are feeling and why you are feeling that way. 

For the most part, Tanzania is roughly about 30-40 years behind many developed countries, especially the US and Europe.  For example, there is very little to almost nothing for those with disabilities.  Palliative care for end stage disease is almost non-existent and pain management is suboptimal.  This can be difficult to see.   The future of nursing and subsequently change in the health care of Tanzania is in the students - and that is a motivation for me.  I have to remind myself that it will come slowly (pole pole).  

It is hard to believe that it is almost the end of January.  I have to say the time is going quickly.  I am slowly getting into the rhythm of living here and have learned when to "exhaust" myself with the sokoni (market) and when to just stay home.  I have been very fortunate to have met some wonderful people and we often eat many of our meals together.   My K-Swahili is coming along pole pole, a little too slowly for my liking.  The students should all speak English - so it will do me or them little good to try to speak K-Swahili with them.  It would be nice to know more, especially with the patient's in the hospital. 

I miss you all and the Northwest - although I have to say, this time of year I don't miss the weather.  Next month, I will meet Jonathan (my youngest son) in Zanzibar.  He is visiting Kenya and Tanzania as a teacher with an alternative high school out of Bellingham; Explorations Academy.  That will certainly be a treat. 

Hope this finds you all well.  Your e-mails are always welcomed.  

Best regards, Dorothy  

My last post for 2013!

Habari - Salama to all my dear family, friends, colleagues and whoever reads my blog -

It is hard to believe that I have been in Africa now for almost 5 months - Some days it seems like a lifetime and other times just yesterday.  Overall, I am doing well -

School is in full swing - and extremely challenging - The biggest challenge is the number of students and the wide variety in their skills.  As I have told you - the students have very little supervision or instruction on the clinical wards - of which they spend about 4 days a week.  Since this seems to be the greatest need, my goal is to spend time with each student mainly on the clinical wards.  I have 22 - 3rd year Diploma students on three wards, the Eye Ward, Oncology and Male Orthopedics.  That is only one group of students - there are also 13 students who are in the Bachelor of Science in Nursing Education program of which most have some experience as nurses, having completed a Diploma program, however there are 7 students who have had no experience as nurses.  It is a challenge to find the best way to accomplish effective learning for each group of students.   For the students to see me come to see them on the wards is a big step; their attendance is even improving.   Over the past few weeks, I have been able to spend about 30 minutes with each student.  They introduce me to their patient and we will discuss the nursing care plan they have prepared and priorities in nursing care for that patient.  Most of the patient's are very sick...and believe me I have seen things there that I only previously saw in textbooks.  It is all very interesting - and everynight I am on the internet finding out something I didn't know.

Often I find myself thinking - this is not how to do things - especially when it comes to student learning - but I am reminded that I was invited here as a guest - and it is not my job to rearrange "the furniture in their house".  At some point I hope to have gained enough credibility that they may ask me what I think - and then will be my opportunity.

Apart from being very busy with school - I have found time to enjoy Tanzania and my ongoing adventure here.  The first part of November I went on my first safari to the Serengeti and Ngorongoro Crater.  It was a 3 day, 2 night camping safari - where we stayed in a tent; one night in the Serengeti and one night on the rim of the crater.

 I went with two Occupational Therapy students from Holland who are working on their master's thesis, two Swedish nursing students,who are here in an exchange program, and one German young man, who is staying with his aunt in Kamanga.  All could have been my children -  We had a great time - the animals were amazing - and as you can see the pop up on the vehicle is great for pictures taking and viewing.

These are just a few - the rest will have to wait until I get back - but we did see the big 5 - which are the  Lion, Elephant, Buffalo, Leopard and Rhinocerous.

The following weekend, was graduation for the Catholic University for Health and Allied Science which includes the school of Medicine, Pharmacy, Laboratory Sciences, Public Health, and Nursing.  My colleage, Linda and I were decked out in full graduation regalia.

Since my last posting I have moved into my permanent housing while here in Mwanza.  It is about a 5 minute walk from the hospital and many of the faculty are my neighbors.  They call them the "chicken houses" - and hard to know why - they sort of look like "chicken coops" but then there is the story that when they were built the nursing students lived in them.  Everyone knows where they are - they have big numbers on the front - (mine is #18)  and I have two bedrooms and a bath - small but adequate kitchen - and fully furnished with actually "brand new" furniture.  My housing is provided by Bugando Medical Center.   I have great neighbors very close - and we eat together about 2-3 times a week.   

The two Swedish nursing students came one night for dinner and made Swedish Meatballs and I had 6 of the 3rd year Diploma nursing students for dinner...all with one frying pan and one pot.  It is amazing what you can do with so little.  I'm loving it.

December 1st was International AID's day and there was a candlelight walk at the Baylor Center for Excellence across the street from Bugando.  Baylor College of Medicine has a center here in Mwanza that treats only children (up to 18) with HIV.  It was a fun event - although sobering as to how Africa has been affected by HIV/AID's.  Now with continual anti-viral medications - many of these children are thriving and have the potential of living productive lives.

Although the work is challenging and there are days I don't know where to even begin - I try to set priorities and continally be flexible.  I can't begin to tell you how many times I thought a class was going to be taught or students were going to be in a certain place at a certain time only to find out minutes or hours before that it had been changed.  If you are someone who wants a set schedule then this is not the place for you - It requires alot of flexibility.   The students also seem very used to the uncertainty of most everything in their lives.    I just say Karibu Tanzania and take a big deep breath.  

 I am enjoying working with the faculty - and they seem to be warming up to me.  I have a "counterpart" here who is the Principle of the Nursing School, Annastazia Pole or Mama Pole as she is referred to.  She is amazing - and really a mover and shaker of nursing in Tanzania.  She is very busy - and often will work into the night preparing for a meeting.  She travels frequently to Dar to meet with the Ministry of Health and has been responsible for much of the standardized curriculum development among the nursing schools in Tanzania.  It is truly an honor to work with her.  A couple of weeks ago, she found time in her schedule to take a few of us including two visiting nursing teachers from Holsohogskolan Jonkoping University in Sweden, out to her village, Bukumbi.  There we visited a small privately run hospital, a certificate nursing school and then had lunch in her village home.  

 

 

The students will be on a break now until January 6th.  I will be here for most of the break and then on December 26th I will go to Madagascar for one week, meeting a colleage who is teaching in Dodoma at Mirembe School of Nursing.  She is also with SEED Global Health.  It should be another chapter in my ongoing African adventure.  

I wish you all peaceful holidays and a very Happy New Year. 

Salama (Be Peaceful) - Dorothy

Habari to all my dear friends and family,
Sorry for the delay in getting this to you -
First, I am well and slowly adjusting to the pace of African life.  It has been an adjustment.  If nothing else I have learned to walk slower, talk slower and overall enjoy each moment.
Everything in life does not have to be done in a "New York Minute".
This is how the Tanzanian's live and work.

Since my last post - although school did not start until 3 weeks ago - I was busy.
I went to Arusha (a one hour plane trip from Mwanza), the beginning of September with 3 doctors who were running a 1/2 marathon, of which I did a 5 K.  It was nice to see another part of Tanzania -

 September 29th is International Heart Day and Bugando Medical Center had a heart walk in full Tananzian style with a band which played the entire time which was to the bottom of Bugando Hill and back.  This picture is of a pediatric cardiologist from Germany who has been here for the past 4 years.  There are a lot of heart problems especially in children, mainly from congenital defects and rheumatic heart disease which we know is very preventable.  Some of the surgeries can be done at Bugando, but most patient's are sent to Nairobi.  The day following the heart walk - there was a free screening for children under 18 of which over 250 were seen.

Some of you have asked me about the weather, the food and how accessible most things that I have previously taken forgranted.
The weather is about 70-80 degrees most days - some days warmer - very little to no humidity and usually a gentle breeze - somewhat like Hawaii.  The tropical sun is very hot - and mid-day is not a good time to be out and about.  However, coming from the Northwest, I don't think I have every sweated so much.
Tanzanian food is interesting - alot of carbs - with a flour mixture called ugali - which they form into a ball and then dip into vegetable or fish stew.  Most eat with their right hand - and before and after each meal they wash their hands -  The markets are full of fresh fruits and vegetables, tomotoes, avocados, mangos, pineapples, potatoes, carrots, onions, garlic, papaya, (most everything you would want).  You buy your fruits and vegetables from the local mamas who sell in the market or by the side of the road.  There are a few small grocery stores - which have unpredicable items - nothing like what you have in the US - more like a 7-11.  I have learned to adjust.  Occasionally there will be something like Philadelphia Cream Cheese - and all the ex-pats go crazy.

I was invited to one of the secretary's home for lunch and it was a true experience in seeing how the local people live.  Very simple life - without running water - but she did have electricity and even a TV.
She lives about a mile from the main road where she catches a bus to work at the medical center.  In fact she has to take two buses.

As I mentioned school has now started for both the Diploma Program at Bugando and the Bachelor of Science in Nursing -Education at the Catholic University of Health and Allied Sciences (CUHAS).  They really are a different group of students.  The Diploma students are generally young (early 20's) and mostly men (there are 5 females in the 2nd year and 9 in the 3rd year).  Their english is fair -
The BSN-ed students are older - have more nursing experience - and if they came into the program from secondary school and without previous nursing experience- they had done quite well in the sciences.  Their English is much better and they seem to be able to grasp more complex topics.  Last week I gave two lectures to this group on the cardiovascular system along with common disorders and they were able understand and discuss later with me what they had learned.
It is very difficult to be talking to a group of students and look out into the audience and see alot of very blank faces - but once I got over that - and tried to make things easier to understand it seemed to get better.  I have to say this is really a work in progress as to how to bring more interaction into the lectures and not just have them copy everything down.  They seem to be very good at that.
I enjoy more spending time with the students on the wards - As I have mentioned there are been very little to no clinical supervision of the Diploma students on the wards.  Currently the 2nd year Diploma students are spending 4 days a week on the clinical wards.  The first thing they do is make beds, of which they wear gloves and masks (not sure why) and then they "dust", wiping down the beds, etc.  The mopping of the floors is done by the cleaning staff.  Then they go for "chai" and finally around 1 pm they pass medications along with the staff nurses, which is a story in itself.  It is rewarding to have them present to me one of their patients and tell me about them.  I have been encouraging them to look things up when they don't know, rather than wait for me to tell them.  Unfortunately there is a sense of "learned helplessness" which has come from a long history - Once they look things up, I have them ask me again and then we spend time going over their questions and what information they have found.   I have also been working with them on some of their clinical skills (like starting IV's and taking blood pressures, etc).

Overall, I am very busy.  I have moved into my permanent housing while I am here in Tanzania.  I will send you a picture of that in my next post - and hopefully it will not be so long in between.  I am living with alot of staff and faculty of Bugando -

The internet and electricity continues to be sporadic - although the hospital is on a generator so is usually not affected.

I have met some great people, many from Europe who are working with organizations at Bugando.

Thank you for all your ongoing - prayers and support.

Salama -
Dorothy

Karibu Tanzania !

Greetings to all my dear friends, family, colleagues and those who want to know about my adventure in Tanzania Nursing.
First off, sorry for the delay - as you can imagine the past almost two months have been crazy to say the least.  After 2 weeks of Peace Corps/SEED Global Health Orientation in Washington DC - with may I add a swearing in of our service at the White House - we arrived in Dar es Salaam on July 21st.  Our first week in Dar was spent meeting the US Ambassador and then the President of Tanzania,  President Kikwete.

The group I am pictured with are all the doctors and nurses who will be serving in Tanzania for the next year.  We are a mix of cardiology, family practice, pediatrics and internal medicine,OB/GYN, midwifery, community health, women's health and general nursing.  Our ages range from early 30's to late 60's.  

Two will be in Dar es Salaam,  one in Mvumi at the Medical Officer's Training School, two in Dodoma at the Mirembe School of Nursing, two at Sengerema District Hospital and two at Bugando Medical Center.  There are also two other Peace Corps Volunteers, spouses of two of the SEED Global Health Volunteers who are serving as well.  One at Baylor Center for Excellence in Mwanza and one in Dar es Salaam.  

After one week in Dar es Salaam with a brief exposure to Swahili, we then went by bus to Dodoma, about 6 hours on a two lane "highway".  Dodoma is actually the capital and where Parliament is located, however it is a small town - We stayed there for one week, working more on our Swahili...and now ninasema Kiswahili (I speak just a little Kiswahili).  

We left those that would be staying in Dodoma; at Mirembe School of Nursing and Mvumi and went back to Dar es Salaam for one night before flying to Mwanza.  Here is a picture of the traffic jam in Dar - 

Traffic in Dar

Plane to Mwanza

Mwanza is where the large regional hospital for the Lake Zone (Western Tanzania) is located and where I will be teaching.  It is 900 beds with some of the sickest patient's, as they are referred from surrounding District Hospitals.  Although it is old and certainly not to US standards in appearance, it is well organized and clean.  The hospital is located on a hill and overlooks Lake Victoria (2nd largest lake in the world) so definitely reminds me a bit of home with the water.  Mwanza is the 2nd largest city in Tanzania and the launching point for safaris to the Serengeti which is about two hours east.

                                                         Bugando Regional Medical Center

Road up to the hospital

I will be teaching in both Bugando School of Nursing and the Catholic University of Allied Health Sciences.  Bugando has a Diploma Program in Nursing - similar to the LVN/LPN program in the US and CUHAS has a Bachelor of Science in Nursing Education.  Fortunately when I arrived, the students were in the process of taking a national final exam and the new class will not start until the middle to end of September.  I have had a chance to meet with the faculty and sort out the courses they would like me to teach.  The biggest need is in the clinical supervision of the students on the wards.   It should all be very interesting.  

I am now familiar with day to day African life.  The Tanzanians are very warm and wonderful people and operate on "Tanzanian time".  This will be a welcomed adjustment.  Greeting one another is the most important part of any encounter - With asking what is new, how are you doing, are you peaceful.  Everyone answers, nzuri or njema (fine).  

Life here is hard, everyone works hard just to live day to day.  The unemployment is high (around 40%) and the median age, if you can imagine is around 17-18.  Only 2% of the population is over 60.

English is taught in the secondary schools -and from what I have observed is not the best, but should improve, hopefully after I spend some time with them.  It will be mutual as I'm sure my Swahlili will also improve.    The nursing courses are all taught in English. 

My housing right now is very nice - in a compound of 4 houses behind a guarded gate.  That is how most "ex pats" live.  In the next month, I will be moving to housing closer to the hospital.  Right now we walk a path over dirt to the paved road leading to the hospital  It takes about 20 minutes.  

A week after arriving here I took the ferry over to Sengerema - where there is a district hospital and where we will be giving some inservice training to the nurses.  This really reminded me of home.  It also gave me a wonderful opportunity to see more of Lake Victoria.

                                                       Ferry to Sengerema

   I have also attached a few pictures of some of the birds and other creatures around my housing, as well as a picture of the lake from a restaurant.  Certainly more will be coming.

Thank you all for your support.  I am happy I came, although there have been days, I thought "what was I ever thinking".  I must add that this place really does "grow" on you and I can see why so many told me "I'd go back in a heart beat". I am so looking forward to working with the students and improving health care and nursing in Tanzania.